title: Extending the reach of stapled anastomosis with a prepared OrVil™ device in laparoscopic oesophageal and gastric cancer surgery.
abstract: BACKGROUND
  The introduction of minimally invasive surgery and the use of laparoscopic techniques have significantly improved patient outcomes and have offered a new range of options for the restoration of intestinal continuity. Various reconstruction techniques have been described and various devices employed but none has been established as superior. This study evaluates our experience with, and modifications of, the orally inserted anvil (OrVil™).
  
  
  METHODS
  We conducted a prospective observational study on 72 consecutive patients who underwent OrVil™-assisted oesophago-gastric or oesophago-jejunal anastomosis between September 2010 and September 2013. We collected data including patient demographics, disease site, type of procedure, location of the anastomosis, involvement of resection margins and peri-operative complications.
  
  
  RESULTS
  Seventy-two patients were included in the study. Patient ages ranged from 45 to 92 years (median ± SD = 69 ± 10 years). Total gastrectomy with Roux-en-Y anastomosis was the most-commonly performed procedure (n = 41; 57 %). R 0 resection was achieved in 67 patients (93 %). There were no Orvil™-related clinical leaks during the study period, and just two patients (2.8 %) demonstrated radiological evidence of leak, both of whom were managed conservatively. There were three in-hospital mortalities during the study period; these were unrelated to the anastomotic technique.
  
  
  CONCLUSIONS
  Despite a steep learning curve, the OrVil™ device is safe and reliable. It also permits the creation of higher trans-hiatal anastomoses without resorting to thoracotomy in high-risk patients with cardia tumours. Certain shortcomings of the device, that had implications for patient safety, were identified and addressed by intra-operative modification during the study period. We commend the use of a prepared OrVil™ device, as a game changer, for upper gastrointestinal reconstruction.
authors.affiliation: Department of Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland, monim.salih@yahoo.ie.
authors.forename: Abdelmonim E A
authors.initials: AE
authors.lastname: Salih
authors.forename: Gary A
authors.initials: GA
authors.lastname: Bass
authors.forename: Yvonne
authors.initials: Y
authors.lastname: D'Cruz
authors.forename: Robert P
authors.initials: RP
authors.lastname: Brennan
authors.forename: Sebastian
authors.initials: S
authors.lastname: Smolarek
authors.forename: Mayilone
authors.initials: M
authors.lastname: Arumugasamy
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Walsh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D004867:Equipment Design; D004938:Esophageal Neoplasms / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013270:Stomach / Q000601:surgery*; D013274:Stomach Neoplasms / Q000601:surgery*; D013536:Suture Techniques / Q000295:instrumentation*