title: Easy method for fixation of the anvil using a one-handed sliding-knot technique after laparoscopic total gastrectomy.
abstract: BACKGROUND
  When esophagojejunostomy is performed using a circular stapler after laparoscopic total gastrectomy, fixing the anvil to the end of the esophagus is challenging. We describe an easy method for fixation of the anvil using a one-handed sliding-knot technique after the anvil has been inserted into the esophagus.
  
  
  METHODS
  After removing the stomach, the main operator makes a whip stitch at the end of the esophagus using a long piece of monofilament string. Both ends of the string are pulled out from the port. A knot is then made and brought close the esophagus twice (sliding granny knots). After inserting the anvil into the esophagus, the main operator pulls the main standing string with one hand, applying vibration only. This causes the knots to tighten the anvil. Then, one or two knots are added to make sure that the anvil is firmly fixed in place. In addition, we routinely add one more ligation with a ready-made ligating loop.
  
  
  CONCLUSIONS
  This method is easy and reliable, and does not require special devices or skills when performing reconstruction after laparoscopic total gastrectomy. Because of these factors, it has the potential to be widely used to perform esophagojejunostomy.
authors.affiliation: Department of Surgery, Kanagawa Prefectual Ashigarakami Hospital, Matsuda, Japan.|Department of Surgery, Yokohama City University, Yokohama, Japan.
authors.forename: Takanobu
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Department of Surgery, Kanagawa Prefectual Ashigarakami Hospital, Matsuda, Japan.|Department of Surgery, Yokohama City University, Yokohama, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Shirai
authors.affiliation: Department of Surgery, Kanagawa Prefectual Ashigarakami Hospital, Matsuda, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Osaragi
authors.affiliation: Department of Surgery, Kanagawa Prefectual Ashigarakami Hospital, Matsuda, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Sujishi
authors.affiliation: Department of Surgery, Kanagawa Prefectual Ashigarakami Hospital, Matsuda, Japan.|Department of Surgery, Yokohama City University, Yokohama, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Kumazu
authors.affiliation: Department of Surgery, Kanagawa Prefectual Ashigarakami Hospital, Matsuda, Japan.|Department of Surgery, Yokohama City University, Yokohama, Japan.
authors.forename: Mariko
authors.initials: M
authors.lastname: Kamiya
authors.affiliation: Department of Surgery, Kanagawa Prefectual Ashigarakami Hospital, Matsuda, Japan.|Department of Surgery, Yokohama City University, Yokohama, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Sugano
authors.affiliation: Department of Surgery, Kanagawa Prefectual Ashigarakami Hospital, Matsuda, Japan.|Department of Surgery, Yokohama City University, Yokohama, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Hatori
authors.affiliation: Department of Surgery, Kanagawa Prefectual Ashigarakami Hospital, Matsuda, Japan.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Yoneyama
authors.affiliation: Department of Surgery, Kanagawa Prefectual Ashigarakami Hospital, Matsuda, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Kasahara
authors.affiliation: Department of Surgery, Yokohama City University, Yokohama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Oshima
authors.affiliation: Department of Surgery, Yokohama City University, Yokohama, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Yukawa
authors.affiliation: Department of Surgery, Yokohama City University, Yokohama, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Rino
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Takaki
authors.initials: T
authors.lastname: Yoshikawa
authors.affiliation: Department of Surgery, Yokohama City University, Yokohama, Japan.
authors.forename: Munetaka
authors.initials: M
authors.lastname: Masuda
authors.affiliation: Department of Surgery, Kanagawa Prefectual Ashigarakami Hospital, Matsuda, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Yamamoto
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D004947:Esophagus / Q000601:surgery*; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy; D010865:Pilot Projects; D013274:Stomach Neoplasms / Q000601:surgery*; D013536:Suture Techniques / Q000295:instrumentation
keywords: Anvil fixation; laparoscopic total gastrectomy; one-handed sliding knot