Using the Hand-Sewn Purse-String Stapled Anastomotic Technique for Minimally Invasive Ivor Lewis Esophagectomy

Zhan, Bicheng; Chen, Jian; Du, Shaoming; Xiong, Yanzheng; Liu, Jian

doi:10.1055/s-0038-1660848

Cited by 11 publications

(12 citation statements)

References 34 publications

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“…21 The feasibility and safety of the robot-assisted lymphadenectomy were demonstrated in a previous study. 22 One of main postoperative complications of EC resection is anastomotic leakage, whose incidence using various anastomosis approaches in the minimally invasive Ivor-Lewis oesophagectomy ranges from 0% to 10%, without statistically significant differences 17,18,23 Here, the anastomotic leakage rate was 3.1% in the RPA group, which is consistent with past studies. According to the doctor's personal experience and intraoperative situation.…”

Section: Discussionsupporting

confidence: 89%

“…17 The OrVil technique is too expensive to be popular, whilst transoral insertion of the anvil raises the chance of thoracic infection and throat injury. 18 In our group, we usually use MPA for oesophagogastric anastomosis during intrathoracic anastomosis because it does not require specialised devices. However, the technique is tedious and difficult to master.…”

Section: Discussionmentioning

confidence: 99%

“…Stapled intrathoracic anastomosis is mainly used when the tumour is located at the distal oesophagus and oesophagogastric junction and includes transthoracic or transoral placement of the anvil and introduction of the circular stapler through a small thoracotomy 17 . The OrVil technique is too expensive to be popular, whilst transoral insertion of the anvil raises the chance of thoracic infection and throat injury 18 . In our group, we usually use MPA for oesophagogastric anastomosis during intrathoracic anastomosis because it does not require specialised devices.…”

Section: Discussionmentioning

confidence: 99%

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A safe and effective anastomotic technique for robot‐assisted minimally invasive oesophagectomy: Reverse‐puncture anastomosis

Peng

Liu

Aimudula

et al. 2021

Robotics Computer Surgery

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Background: Oesophagogastric anastomosis is mainly complicated by its tediousness. We hope to modify an oesophagogastric anastomotic technique that simplifies anastomosis. Methods:We conducted a retrospective analysis of 57 cases executed using reverse-puncture anastomotic (RPA) technique and 64 cases of manual purse anastomosis (MPA) technique for robot-assisted minimally invasive oesophagectomy (RAMIE). Baseline characteristics and perioperative outcomes were analysed.Results: There were no significant differences between the 2 groups with regards to demographic data and clinical features. All patients had R0 resection.Relative to MPA, RPA group experienced significantly shorter operation times (232.5 � 33.84 min vs. 262.3 � 83.94 min, p = 0.038).RPA group patients had shorter anastomotic times relative to MPA group patients (10.5 � 3.4 min vs.18.3 � 4.1 min, p = 0.014). No adverse events were observed. Conclusions:Reverse-puncture anastomosis is safe, feasible in RAMIE. This approach has the potential to efficiently shorten the anastomotic time and ensure safe operation.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A safe and effective anastomotic technique for robot‐assisted minimally invasive oesophagectomy: Reverse‐puncture anastomosis

Peng

Liu

Aimudula

et al. 2021

Robotics Computer Surgery

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“…Anastomosis-related complications especially anasomotic leakage is one of the most lethal comorbidies, usually resulting in pyothorax, mediastinitis, tracheal fistula, arterial fistula or septicemia, and ending up with multiple organ failure eventually. In order to achieve satisfactory esophagogastric anastomosis, much effort had been tried either to optimize the anasomotic procedure (18,19,(30)(31)(32)(33)(34)(35)(36)(37), to better off the blood flow at the anastomotic site on the grafted conduits (11,38,39), or to manage prophylactic measurements to ensure the confinement of inflammation and facilitate the healing in case of leakage (20,21). In the present study we evaluated the utility of MOMA and compared it with CDHA in cervical esophagogastric anastomosis after sub-total esophagectomy in TE-SCC patients.…”

Section: Discussionmentioning

confidence: 99%

Comparison of a modified one‑piece mechanical and double‑layer hand‑sewn anastomosis in McKeown esophagogastrectomy: A single‑institute retrospective study

et al. 2021

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The present study aimed to introduce a novel method of cervical esophagogastric anastomosis, so-called 'modified one-piece mechanical anastomosis' (MOMA) in McKeown esophagogastrectomy and to compare its feasibility, efficacy and safety with those of 'conventionally double-layer hand-sewn anastomosis' (CDHA). Between March 2016 and March 2018, 80 consecutive patients with thoracic esophageal squamous cell carcinoma undergoing McKeown esophagogastrectomy with a curative intent were included in the present study. Among them, 40 received MOMA and the other 40 received CDHA. Their medical records, including operation time, anastomotic time, estimated blood loss, postoperative complications within 30 days, as well as survival rate, were retrospectively reviewed, analyzed and compared. Total operation time, anastomotic time and estimated blood loss in the MOMA group were significantly decreased compared with those in the CDHA group (207.73±2.66 vs. 225.40±3.43 min; 10.95±0.44 vs. 23.03±0.47 min; 144.50±21.14 vs. 241.75±23.75 ml; all P<0.01). Anastomotic leakage was present in 1 patient in the CDHA group, but no patients in the MOMA group (P=1.000). Anastomotic stenosis was documented in 4 and 2 patients in the MOMA and CDHA group, respectively (P=0.392). The 30-day operative mortality was 0% and no significant difference was demonstrated in postoperative complications within groups (P>0.05). Furthermore, the disease-free and overall survival was compared by means of Kaplan-Meier survival estimates and log-rank tests and no statistical difference was determined (P=0.5114 and P=0.7875, respectively). McKeown esophagogastrectomy with MOMA may be a feasible, effective and reproducible alternative with relatively satisfactory postoperative outcomes for the treatment of TE-SCC, providing shorter operation and anastomosis times, and less estimated intraoperative blood loss.

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“…The most commonly applied technique is a circular stapler anastomosis which involves placement of an anvil and circular stapler inside a gastric conduit (4). Although there are several practical versions, the placement of a pursestring suture on the esophagus is technically demanding and sometimes muscular approximation is not perfect (4,9). Semi-stapled anastomosis involves a posterior stapler line, and separate sutures on the anterior part (10).…”

Section: Discussionmentioning

confidence: 99%

Uniportal video-assisted thoracic surgery for esophageal cancer

Batırel

2017

J. Vis. Surg.

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Classical video-assisted thoracic surgery (VATS) approach to esophageal cancer uses four incisions. The rationale is to facilitate movement of the instruments and the esophagus and also suturing during placement of a purse-string suture for an intrathoracic anastomosis. Uniportal VATS (U-VATS) is challenge for surgeons, as you have to do an esophageal mobilization and anastomosis from a single 3-5 cm incision. The incision is placed either at the 5th or 6th intercostal space close to the posterior axillary line. Esophagus is mobilized en bloc with the subcarinal and periesophageal lymph nodes. The crucial parts are inclusion of subcarinal lymph node in the specimen, mobilization of the specimen from the left main bronchus and esophagogastric anastomosis. Esophagus is encircled with a thick penrose drain and retracted anterior and posteriorly during this dissection. Once the esophagus is completely mobilized, if an intrathoracic anastomosis is to be performed, gastric conduit is pulled inside the chest in correct orientation. A linear completely stapled side to side anastomosis is performed. A thick tissue endoscopic stapler is used for posterior and anterior wall. A single chest drain is placed and incision is closed. There are several intrathoracic anastomotic techniques. All of these techniques can be applied through a uniportal approach. Side to side completely stapled anastomosis is safe, fast and easy to perform. There is a single report on esophagectomy comparing uniportal and multiportal VATS approaches in esophageal cancer which showed comparable results in terms of duration of surgery, amount of bleeding, lymph node yield and leak rates. U-VATS for esophageal cancer is emerging as a new approach and the technique is feasible and certainly future studies will show if it is reproducible and provides a clinical advantage for the patient.

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Using the Hand-Sewn Purse-String Stapled Anastomotic Technique for Minimally Invasive Ivor Lewis Esophagectomy

Abstract: Using the hand-sewn purse-string stapled anastomotic technique for MIILE is feasible and relatively safe in patients with middle or lower esophageal cancer.

Cited by 11 publications

References 34 publications

A safe and effective anastomotic technique for robot‐assisted minimally invasive oesophagectomy: Reverse‐puncture anastomosis

A safe and effective anastomotic technique for robot‐assisted minimally invasive oesophagectomy: Reverse‐puncture anastomosis

Comparison of a modified one‑piece mechanical and double‑layer hand‑sewn anastomosis in McKeown esophagogastrectomy: A single‑institute retrospective study

Uniportal video-assisted thoracic surgery for esophageal cancer

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