title: Laparoscopic total gastrectomy using the transorally inserted anvil (OrVil™): a preliminary, single institution experience.
abstract: Laparoscopic total gastrectomy (LTG) is not a commonly performed procedure due to the difficulty associated with surgical reconstruction. We present our preliminary results after intracorporeal circular stapling esophagojejunostomy using the newly developed transorally inserted anvil (OrVil™, Covidien, MA, USA). Between 2008 and June 2013, 51 patients underwent laparoscopic gastrectomy with D2 lymph node dissection for gastric cancer. A total of 12 patients underwent LTG: of these, 5 received an intracorporeal linear side-to-side esophagojejunal anastomosis and the remaining 7 underwent intracorporeal circular stapling esophagojejunostomy using the OrVil™ system. Short-term outcomes were compared between the two groups. There were no intraoperative complications or conversions to open surgery in any patients. The mean operative time was significantly shorter in the OrVil™ than in the side-to-side group (261.4 ± 12.0 vs 333.0 ± 15.0 minutes, respectively, p = 0.005). Postoperative fluorography revealed no anastomosis leakage or stenosis in either groups. All patients resumed an oral liquid diet on postoperative day 5 and the mean postoperative hospital stay was 9 days. Intracorporeal circular stapling esophagojejunostomy using the OrVil™ system is technically feasible and safe in LTG. This technique may be considered a simple and time-saving alternative to the side-to-side linear esophagojejunostomy.
authors.affiliation: Department of Surgery and Translational Medicine, University of Florence, Florence, Italy ; Endocrine and Minimally Invasive Surgery, Azienda Ospedaliero-Universitaria Careggi, Center of Oncologic Minimally Invasive Surgery (COMIS), Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Cianchi
authors.affiliation: Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Macrì
authors.affiliation: IFCA, Florence, Italy.
authors.forename: Giampiero
authors.initials: G
authors.lastname: Indennitate
authors.affiliation: ISPO, Florence, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Mallardi
authors.affiliation: Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Trallori
authors.affiliation: Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Biagini
authors.affiliation: Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Badii
authors.affiliation: Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Staderini
authors.affiliation: Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Perigli
keywords: Esophagojejunal anastomosis; Gastric cancer; Intracorporeal circular stapling; Laparoscopic total gastrectomy