Intrathoracic esophagogastric anastomosis using a linear stapler following minimally invasive esophagectomy in the prone position.
BACKGROUND
Minimally invasive esophagectomy (MIE) in the prone position typically includes thoracoscopic mediastinal dissection and laparoscopic gastric tube construction, followed by esophagogastric anastomosis in the neck. We introduced an intrathoracic esophagogastric anastomosis using linear staplers.


METHODS
The lower mediastinal dissection and the gastric tube construction are done in the laparoscopic part of the operation. The esophagus is transected at the cranial level of the aortic arch after the completion of the upper mediastinal lymph node dissection in the prone position. The excess length of the gastric tube is sacrificed before making the anastomosis. Side-to-side esophagogastric anastomosis is performed using a 35-mm endoscopic linear stapler. The entry hole is closed with hand suturing using the posterior and the axillary port.


RESULTS
Twenty-six patients with middle or lower esophageal tumor underwent MIE with an intrathoracic anastomosis. The mean thoracoscopic procedure time was 302 min. One patient had an anastomotic leakage, which was successfully managed with drainage. There has been no anastomotic stenosis. Pneumonia was observed in two patients. There was no mortality.


CONCLUSIONS
MIE with an intrathoracic linear-stapled anastomosis with the patient in the prone position is safe and feasible.
Department of Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan. hokabe@kuhp.kyoto-u.ac.jp
Hiroshi
H
Okabe
Eiji
E
Tanaka
Shigeru
S
Tsunoda
Kazutaka
K
Obama
Yoshiharu
Y
Sakai
D000368:Aged; D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000379:methods*; D016684:Prone Position; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D013528:Surgical Staplers; D013906:Thoracoscopy