An automatically contamination-avoiding technique for intracorporeal esophagojejunostomy using a transorally inserted anvil during laparoscopic total gastrectomy for gastric cancer.
BACKGROUND
Intracorporeal Roux-en-Y esophagojejunostomy during laparoscopic total gastrectomy for gastric cancer remains a challenging manipulation due to the uncontrolled direction of the jejunal side or unintended embedded tissues, although several methods have been introduced. In this study, we simplified the procedure based on a surgical string fixing technique using a transorally inserted anvil (OrVil™; Covidien Ltd., Mansfield, MA, USA).


METHODS
From March 2012 to September 2013, 14 consecutive patients underwent simplified intracorporeal Roux-en-Y esophagojejunostomy using OrVil™ during laparoscopic total gastrectomy for gastric cancer at our hospital. Clinicopathologic characteristics and surgical outcomes of these patients were retrospectively analyzed.


RESULTS
All of the procedures were successful completed with no complication or conversion to open surgery. The mean overall operative time was 193.8 ± 41.8 min, whereas the mean reconstruction time was 32.6 ± 4.6 min. The mean estimated blood loss was 105.7 ± 65.4 ml. The mean diameter of anastomosis measured by upper gastrointestinal contrast X-ray test at 1 month after operation was 2.3 cm. During a median follow-up period of 12 months, neither local recurrence nor anastomosis-related morbidity was observed.


CONCLUSIONS
Our preliminary results suggested that this automatically contamination-avoiding technique based on a surgical-string-fixing strategy using OrVil™ during laparoscopic total gastrectomy for gastric cancer might be feasible and safe and provide a simple solution for intracorporeal Roux-en-Y esophagojejunostomy.
Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838 The North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China. yfenghu@qq.com.
Yan-Feng
YF
Hu
Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838 The North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China. wonder0618.dw@gmail.com.|The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Department of Surgical Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jie-Fang Road, Hangzhou, 310009, Zhejiang Province, China. wonder0618.dw@gmail.com.
Da
D
Wang
Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838 The North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China. 342234191@qq.com.
Tian
T
Lin
Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838 The North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China. 190552177@qq.com.
Ting-Yu
TY
Mou
Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838 The North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China. 505176434@qq.com.
Hao
H
Liu
Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838 The North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China. 2053196573@qq.com.
Tao
T
Chen
Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838 The North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China. 1697960280@qq.com.
Zhen-Wei
ZW
Deng
Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838 The North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China. 425594684@qq.com.
Xin
X
Lu
Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838 The North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China. balbc@163.com.
Jiang
J
Yu
Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838 The North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China. gzliguoxin@163.com.
Guo-Xin
GX
Li
D000714:Anastomosis, Surgical / Q000379:methods*; D004866:Equipment Contamination / Q000517:prevention & control*; D004946:Esophagostomy; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D013274:Stomach Neoplasms / Q000601:surgery*; D017792:Surgical Stapling; D013536:Suture Techniques / Q000295:instrumentation*