Abstract
Objectives: In expert hands, the intrathoracic oesophago-gastric anastamosis usually provides a low rate of strictures and leaks. However, anastomoses can be technically challenging and time consuming when minimally invasive techniques are used. We present our preliminary results of a standardised 25 mm/4.8 mm circular-stapled anastomosis using a trans-orally placed anvil. Materials and methods: We evaluated a prospective cohort of 37 consecutive patients offered minimally invasive Ivor Lewis oesophagectomy at a tertiary referral centre. The oesophago-gastric anastomosis was created using a 25-mm anvil (Orvil, Autosuture, Norwalk, CT, USA) passed trans-orally, in a tilted position, and connected to a 90-cm long polyvinyl chloride delivery tube through an opening in the oesophageal stump. The anastomosis was completed by joining the anvil to a circular stapler (end-to-end anastomosis stapler (EEA XL) 25 mm with 4.8-mm staples, Autosuture, Norwalk, CT, USA) inserted into the gastric conduit. Primary outcomes were leak and stricture rates. Results: Thirty-seven patients (mean age 65 years) with distal oesophageal adenocarcinoma (n = 29), squamous cell cancer (n = 5) or high-grade dysplasia in Barrett's oesophagus (n = 3) underwent an Ivor Lewis oesophagectomy between October 2007 and August 2009. The abdominal portion was operated laparoscopically in 30 patients (81.1%). The thoracic portion was done using a muscle-sparing mini-thoracotomy in 23 patients (62.2%) and thoracoscopic techniques in 14 patients (37.8%). There were no intra-operative technical failures of the anastomosis or deaths. Five patients had strictures (13.5%) and all were successfully treated with endoscopic dilations. One patient had an anastomotic leak (2.7%) that was successfully treated by re-operation and endoscopic stenting of the anastomosis. Discussion: The circular-stapled anastomosis with the trans-oral anvil allows for an efficient, safe and reproducible anastomosis. This straightforward technique is particularly suited to the completely minimally invasive Ivor Lewis oesophagectomy.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1421-1426 |
| Number of pages | 6 |
| Journal | European Journal of Cardio-thoracic Surgery |
| Volume | 37 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 2010 |
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Keywords
- Anastomose
- Complications
- Minimally invasive
- Oesophageal cancer
- Oesophagectomy
- Stapler
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Surgery
- Pulmonary and Respiratory Medicine
Cite this
A safe and reproducible anastomotic technique for minimally invasive Ivor Lewis oesophagectomy : the circular-stapled anastomosis with the trans-oral anvil. / Campos, Guilherme M.; Jablons, David; Brown, Lisa M; Ramirez, René M.; Rabl, Charlotte; Theodore, Pierre.
In: European Journal of Cardio-thoracic Surgery, Vol. 37, No. 6, 06.2010, p. 1421-1426.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - A safe and reproducible anastomotic technique for minimally invasive Ivor Lewis oesophagectomy
T2 - the circular-stapled anastomosis with the trans-oral anvil
AU - Campos, Guilherme M.
AU - Jablons, David
AU - Brown, Lisa M
AU - Ramirez, René M.
AU - Rabl, Charlotte
AU - Theodore, Pierre
PY - 2010/6
Y1 - 2010/6
N2 - Objectives: In expert hands, the intrathoracic oesophago-gastric anastamosis usually provides a low rate of strictures and leaks. However, anastomoses can be technically challenging and time consuming when minimally invasive techniques are used. We present our preliminary results of a standardised 25 mm/4.8 mm circular-stapled anastomosis using a trans-orally placed anvil. Materials and methods: We evaluated a prospective cohort of 37 consecutive patients offered minimally invasive Ivor Lewis oesophagectomy at a tertiary referral centre. The oesophago-gastric anastomosis was created using a 25-mm anvil (Orvil, Autosuture, Norwalk, CT, USA) passed trans-orally, in a tilted position, and connected to a 90-cm long polyvinyl chloride delivery tube through an opening in the oesophageal stump. The anastomosis was completed by joining the anvil to a circular stapler (end-to-end anastomosis stapler (EEA XL) 25 mm with 4.8-mm staples, Autosuture, Norwalk, CT, USA) inserted into the gastric conduit. Primary outcomes were leak and stricture rates. Results: Thirty-seven patients (mean age 65 years) with distal oesophageal adenocarcinoma (n = 29), squamous cell cancer (n = 5) or high-grade dysplasia in Barrett's oesophagus (n = 3) underwent an Ivor Lewis oesophagectomy between October 2007 and August 2009. The abdominal portion was operated laparoscopically in 30 patients (81.1%). The thoracic portion was done using a muscle-sparing mini-thoracotomy in 23 patients (62.2%) and thoracoscopic techniques in 14 patients (37.8%). There were no intra-operative technical failures of the anastomosis or deaths. Five patients had strictures (13.5%) and all were successfully treated with endoscopic dilations. One patient had an anastomotic leak (2.7%) that was successfully treated by re-operation and endoscopic stenting of the anastomosis. Discussion: The circular-stapled anastomosis with the trans-oral anvil allows for an efficient, safe and reproducible anastomosis. This straightforward technique is particularly suited to the completely minimally invasive Ivor Lewis oesophagectomy.
AB - Objectives: In expert hands, the intrathoracic oesophago-gastric anastamosis usually provides a low rate of strictures and leaks. However, anastomoses can be technically challenging and time consuming when minimally invasive techniques are used. We present our preliminary results of a standardised 25 mm/4.8 mm circular-stapled anastomosis using a trans-orally placed anvil. Materials and methods: We evaluated a prospective cohort of 37 consecutive patients offered minimally invasive Ivor Lewis oesophagectomy at a tertiary referral centre. The oesophago-gastric anastomosis was created using a 25-mm anvil (Orvil, Autosuture, Norwalk, CT, USA) passed trans-orally, in a tilted position, and connected to a 90-cm long polyvinyl chloride delivery tube through an opening in the oesophageal stump. The anastomosis was completed by joining the anvil to a circular stapler (end-to-end anastomosis stapler (EEA XL) 25 mm with 4.8-mm staples, Autosuture, Norwalk, CT, USA) inserted into the gastric conduit. Primary outcomes were leak and stricture rates. Results: Thirty-seven patients (mean age 65 years) with distal oesophageal adenocarcinoma (n = 29), squamous cell cancer (n = 5) or high-grade dysplasia in Barrett's oesophagus (n = 3) underwent an Ivor Lewis oesophagectomy between October 2007 and August 2009. The abdominal portion was operated laparoscopically in 30 patients (81.1%). The thoracic portion was done using a muscle-sparing mini-thoracotomy in 23 patients (62.2%) and thoracoscopic techniques in 14 patients (37.8%). There were no intra-operative technical failures of the anastomosis or deaths. Five patients had strictures (13.5%) and all were successfully treated with endoscopic dilations. One patient had an anastomotic leak (2.7%) that was successfully treated by re-operation and endoscopic stenting of the anastomosis. Discussion: The circular-stapled anastomosis with the trans-oral anvil allows for an efficient, safe and reproducible anastomosis. This straightforward technique is particularly suited to the completely minimally invasive Ivor Lewis oesophagectomy.
KW - Anastomose
KW - Complications
KW - Minimally invasive
KW - Oesophageal cancer
KW - Oesophagectomy
KW - Stapler
UR - http://www.scopus.com/inward/record.url?scp=77952586141&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77952586141&partnerID=8YFLogxK
U2 - 10.1016/j.ejcts.2010.01.010
DO - 10.1016/j.ejcts.2010.01.010
M3 - Article
C2 - 20153660
AN - SCOPUS:77952586141
VL - 37
SP - 1421
EP - 1426
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
SN - 1010-7940
IS - 6
ER -