title: Thoracoscopic purse string technique for minimally invasive Ivor Lewis esophagectomy.
abstract: OBJECTIVE
  Thoracolaparoscopic esophagectomy with chest anastomosis (TLE-chest) is increasingly performed for middle and lower esophageal cancer; however, gastroesophageal anastomosis for this surgery remains both challenging and inefficient. To address this issue, we previously reported our MIE technique with Ivor-Lewis anastomosis. Here we present the video to introduce our TLE-chest operation procedures.
  
  
  METHODS
  TLE-chest with a combined thoracoscopic and laparoscopic technique was performed by one group of surgeons. From October 2011 to September 2013, 80 esophageal cancer patients were treated with TLE-chest using this improved anastomotic technique.
  
  
  RESULTS
  The surgery was successful for all patients, although the anastomosis in one patient required intraoperative manual repair. No patients required open conversion. In this video, dissociation of stomach, and dissection of lymph nodes, creation of gastric tube and staple line embedding, jejunostomy were carried out by laparoscopic surgery. Dissection of esophageal cancer and mediastinal lymph nodes were done through rib 3 or 4 by a 3-4 cm video-assisted right anterior minithoracotomy, then esophago-gastric anastomosis was performed in right thoracic cavity This video shows the R0 resection of T3N0M0 esophageal cancer. Totally, 36 lymph nodes were dissected, including 21 mediastinal lymph nodes and 15 abdominal lymph nodes. The patient recovered well and was discharged on day 8 after the surgery, with good short term outcomes.
  
  
  CONCLUSIONS
  A safe, cost effective purse string stapled anastomotic technique has been presented for TLE-chest in our video. It is consistent with the oncology principles.
authors.affiliation: Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
authors.forename: Renquan
authors.initials: R
authors.lastname: Zhang
authors.affiliation: Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
authors.forename: Ningning
authors.initials: N
authors.lastname: Kang
authors.affiliation: Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
authors.forename: Wanli
authors.initials: W
authors.lastname: Xia
authors.affiliation: Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Che
authors.affiliation: Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Wan
authors.affiliation: Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
authors.forename: Zaicheng
authors.initials: Z
authors.lastname: Yu
keywords: Esophageal cancer; anastomosis (gastroesophageal); esophageal surgery; thoracolaparoscopic esophagectomy