title: A simple technique for performing laparoscopic purse-string suturing during circular stapling anastomosis.
abstract: An esophagojejunostomy using a circular stapler requires the fixing of an anvil at the esophageal stump. When this placement procedure is laparoscopically performed, purse-string suturing is difficult, and there is a risk of loosening when a conventional needle driver is used. We herein present a simple but effective technique for performing laparoscopic purse-string suturing of the esophageal stump using a semiautomatic suturing device called the Endostitch. Gastrointestinal anvil placement was laparoscopically performed for 10 patients who underwent an esophagojejunostomy following a total gastrectomy. After the lumen of the esophagus was expanded using bowel forceps, the Endostitch was used to place approximately 12 encircling purse-string sutures. An anvil was positioned with support of the esophageal wall at three points with forceps. The Endostitch was used for the ligation with a sufficient degree of tension applied by extracorporeally pulling the sutures through the abdominal wall. The time for placement of the anvil averaged approximately 8 min. The ring formation following anastomosis was favorable in all patients. As a result, we consider our technique to be simple but very effective.
authors.affiliation: Department of Surgery and Clinical Oncology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0876, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Takiguchi
authors.forename: Mitsugu
authors.initials: M
authors.lastname: Sekimoto
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miyata
authors.forename: Takushi
authors.initials: T
authors.lastname: Yasuda
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
authors.forename: Masahiko
authors.initials: M
authors.lastname: Yano
authors.forename: Morito
authors.initials: M
authors.lastname: Monden
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D004947:Esophagus / Q000601:surgery*; D005743:Gastrectomy / Q000379:methods; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D012680:Sensitivity and Specificity; D017792:Surgical Stapling; D013536:Suture Techniques