title: Feasibility of a high intrathoracic esophagogastric anastomosis without thoracic access after laparoscopic-assisted transhiatal esophagectomy: a pilot experimental study.
abstract: BACKGROUND
  The aim of the present study was to evaluate the feasibility of a technique that uses solely the transhiatal approach to create a high intrathoracic esophagogastric anastomosis after laparoscopic transhiatal resection of the distal esophagus.
  
  
  METHODS
  Using a laparoscopic approach, the esophagi of 10 midsized pigs were dissected and transected as high as possible in the thorax, and the anvil of a circular stapler was introduced perorally into the esophageal stump. Through a midline short laparotomy, the circular stapler was inserted into the gastric tube and advanced through the hiatus to be connected with the anvil and create the anastomosis.
  
  
  RESULTS
  Development of the technique was completed within the first 6 experiments. The last 4 operations were entirely successful, standardized, and easily reproducible.
  
  
  CONCLUSIONS
  The technique is feasible in this experimental setting. Further studies are required to establish if there is a clinical role for this technique in esophageal surgery.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany. vabintintan@yahoo.com
authors.forename: Vasile V
authors.initials: VV
authors.lastname: Binţinţan
authors.forename: Arianeb
authors.initials: A
authors.lastname: Mehrabi
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Fonouni
authors.forename: Majid
authors.initials: M
authors.lastname: Esmaeilzadeh
authors.forename: Beat P
authors.initials: BP
authors.lastname: Müller-Stich
authors.forename: Gheorghe
authors.initials: G
authors.lastname: Funariu
authors.forename: Constantin
authors.initials: C
authors.lastname: Ciuce
authors.forename: Carsten N
authors.initials: CN
authors.lastname: Gutt
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000379:methods*; D005240:Feasibility Studies; D013270:Stomach / Q000601:surgery; D013274:Stomach Neoplasms / Q000601:surgery; D017792:Surgical Stapling; D013552:Swine