Novel thoracoscopic intrathoracic esophagogastric anastomosis technique for patients with esophageal cancer

Background: This article describes a novel, easy, and secure thoracoscopic intrathoracic esophagogastric anastomosis procedure that uses a circular stapler with transoral placement of the anvil for patients with esophageal cancer who underwent thoracoscopic esophagectomy. Methods: After the thoracoscopic esophagectomy, the esophagus was transected obliquely at the level of the upper posterior mediastinum using a linear stapler. The Orvil™ (Autosuture, Norwalk, CT) anvil was placed at the edge of the staple line of the esophageal stump, which was relatively at an acute angle to the stump. Next the gastric conduit was pulled through the esophageal hiatus into the right thoracic cavity. The shaft of a 25-mm circular stapler was inserted and placed into the gastric conduit from the gastrotomy. Circular stapling was undertaken in a conventional manner. The access opening on the stump of the gastric conduit was closed with a linear stapler intracorporeally. Results: The anastomotic procedure was completed in 20 patients. Intraoperative complications or conversions to open surgery from thoracoscopic surgery were not observed in any patient. There were no severe postoperative complications, such as anastomotic leaks or gastric conduit necrosis. Conclusion: The present study revealed that our novel thoracoscopic intrathoracic esophagogastric anastomosis was technically easy and safe with minimal morbidity.