title: Laparoscopic esophagojejunostomy using the EndoStitch and a circular stapler under a direct view created by the ENDOCAMELEON.
abstract: Laparoscopic esophagojejunostomy using a circular stapler is associated with technical difficulties in the purse-string sutures used to insert the anvil head and in obtaining an adequate visual field to prevent rolling the mesentery and the wall of the jejunum on the mesenteric side into the anastomosis. To overcome these difficulties, we used the EndoStitch to create the purse-string suture and the ENDOCAMELEON to create the visual field to stretch the jejunum. After resecting the esophagus, purse-string sutures were placed using the EndoStitch. A total of five to six needle deliveries were performed. Next, the anvil head was inserted into the esophagus. The main unit of the EEA was inserted from the end of the resected jejunum. Then, the scope was changed to the ENDOCAMELEON. The main unit was slowly moved toward the anvil head. After making sure that the mesentery and the wall of the jejunum on the mesenteric side were not rolled into the anastomosis under the visual field created by the ENDOCAMELEON, the main unit was then fired. Thereafter, esophagojejunostomy was successfully completed. This technique was applied in 20 patients between April 2010 and May 2012. Laparoscopic esophagojejunostomy after total gastrectomy for gastric cancer was completed in all 20 patients. No case required conversion to open surgery. Neither anastomotic leakage nor stenosis was observed. This method is simple and useful for laparoscopic esophagojejunostomy after total gastrectomy for gastric cancer.
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-Ku, Yokohama, 241-0815, Japan, yoshikawat@kcch.jp.
authors.forename: Takaki
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Hayashi
authors.forename: Toru
authors.initials: T
authors.lastname: Aoyama
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Cho
authors.forename: Hirohito
authors.initials: H
authors.lastname: Fujikawa
authors.forename: Junya
authors.initials: J
authors.lastname: Shirai
authors.forename: Shinichi
authors.initials: S
authors.lastname: Hasegawa
authors.forename: Takanobu
authors.initials: T
authors.lastname: Yamada
authors.forename: Takashi
authors.initials: T
authors.lastname: Oshima
authors.forename: Norio
authors.initials: N
authors.lastname: Yukawa
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Rino
authors.forename: Munetaka
authors.initials: M
authors.lastname: Masuda
authors.forename: Takashi
authors.initials: T
authors.lastname: Ogata
authors.forename: Akira
authors.initials: A
authors.lastname: Tsuburaya
mesh_terms: D000714:Anastomosis, Surgical; D013505:Digestive System Surgical Procedures; D004947:Esophagus / Q000601:surgery*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy; D009367:Neoplasm Staging; D011379:Prognosis; D017792:Surgical Stapling; D013536:Suture Techniques