title: Endoscopic-assisted intrathoracic oesophagogastrostomy without thoracotomy for tumours of the lower oesophagus and cardia.
abstract: OBJECTIVE
  This study aimed to evaluate the efficacy of a novel technique enabling a trans-hiatal oesophagectomy with intrathoracic anastomosis under direct vision, without thoracotomy.
  
  
  METHODS
  Trans-hiatal dissection of the oesophagus was performed using direct and laparoscopic visualization. The oesophagus was transected above the tumour with a linear endo-GIA-2 60 mum stapler. The stomach was transected and a gastric tube fashioned. The anvil of an appropriately sized CEEA circular stapler was modified enabling it to flatten. It was attached to a novel delivery system introduced under direct vision along a guidewire into the stapled oesophagus. The anvil was realigned to its original position in the distal oesophagus, docked with the body of the stapler and an intrathoracic anastomosis performed.
  
  
  RESULTS
  Ten patients (female n=3, male n=7) aged from 39--77 years (mean age 65 years), ASA 2--3 with distal third tumours were treated. Duration of procedure ranged from 2--5 hours (mean 4 hours). One patient suffered a post-operative chest infection and an anastomotic leak treated successfully with a self-expanding metal stent. Hospital stay ranged from 6--28 days (mean 17 days). There was no mortality.
  
  
  CONCLUSIONS
  This technique allows a safe intrathoracic anastomosis to be performed trans-hiatally under direct vision, avoiding the need for thoracotomy in patients with high comorbidity.
authors.affiliation: Department of Surgery, Leicester General Hospital, Leicester, UK. crisdsutton@hotmail.com
authors.forename: C D
authors.initials: CD
authors.lastname: Sutton
authors.forename: S A
authors.initials: SA
authors.lastname: White
authors.forename: L J
authors.initials: LJ
authors.lastname: Marshall
authors.forename: D P
authors.initials: DP
authors.lastname: Berry
authors.forename: P S
authors.initials: PS
authors.lastname: Veitch
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D002299:Cardia; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013270:Stomach / Q000601:surgery*; D013274:Stomach Neoplasms / Q000601:surgery*; D017792:Surgical Stapling