title: Laparoscopy-assisted esophagoenteral anastomosis using endoscopic purse-string suture instrument "Endo-PSI (II)" and circular stapler.
abstract: It is said that laparoscopic esophagoenteral anastomosis is not easy. In particular, purse-string suture of the abdominal esophagus is difficult when using a circular stapler. We have developed an endoscopic purse-string suture instrument, the "Endo-PSI (II)", and the instrument was employed clinically during laparoscopy-assisted total gastrectomy. The device was inserted into the abdominal cavity through a 4-cm minilaparotomy of the epigastrium, and pneumoperitoneum was established by closing a Lap Disc. The Endo-PSI (II) was attached to the abdominal esophagus and a straight needle with a 2-0 polypropylene suture was passed through the device laparoscopically. After a purse-string suture of the abdominal esophagus was made, the abdominal esophagus was transected laparoscopically and the removed stomach was pulled out through the minilaparotomy. The anvil head of a circular stapler was inserted into the abdominal cavity through the minilaparotomy, and insertion of the anvil into the esophagus and ligation of the purse-string suture were performed laparoscopically, too. The combination of using a circular stapler for esophagojejunostomy and closure of the jejunal stump was also performed laparoscopically. Between May 2007 and May 2008, these products were used in 23 patients during laparoscopy-assisted total gastrectomy. There were no cases that required conversion to a conventional open procedure. The newly developed Endo-PSI (II) was useful for laparoscopic purse-string suture of the esophagus.
authors.affiliation: Department of Surgery, Tsuchiura Kyodo General Hospital, 11-7 Manabe-shinmachi, Tsuchiura, Ibaraki 300-0053, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Usui
authors.forename: Kentaro
authors.initials: K
authors.lastname: Nagai
authors.forename: Susumu
authors.initials: S
authors.lastname: Hiranuma
authors.forename: Noriaki
authors.initials: N
authors.lastname: Takiguchi
authors.forename: Akio
authors.initials: A
authors.lastname: Matsumoto
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Sanada
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D004766:Enterostomy / Q000295:instrumentation / Q000379:methods; D004946:Esophagostomy / Q000379:methods; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007582:Jejunostomy / Q000379:methods; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013528:Surgical Staplers; D013536:Suture Techniques / Q000295:instrumentation*