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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_536_Библиотеки_им_академика_М_И_Перельмана.pdf
17721 Intrathoracic Esophago-Gastrostomy …
Fig. 21.6 Introduction of the EEA in the gastric conduit through the mini-thoracotomy. The EEA device through the gel cap is introduced into
the thoracic cavity. Close (a, b, c) and schematic view (d)
178 F. Mingol Navarro
Fig. 21.7 The two ends of the EEA and the anvil are joined. Both ends are adjusted. End-to side anastomosis is performed. Close (a, b, c) and
schematic view (d)
Fig. 21.8 General view of the adjustment of the two ends of the EEA. The EEA is retrieved (a, b)
Fig. 21.9 View of the resection of the lateral loop of the gastric conduit by a 60 mm endostapler. Close (a) and schematic view (b)
Fig. 21.10 Interrupted
stitches at the stapler’s
section
17921 Intrathoracic Esophago-Gastrostomy …
180 F. Mingol Navarro
Fig. 21.11 The omentum is placed around the anastomosis and gastric conduit as wrap. A clip is used to fix the omentum to the edge of the
pleura (a, b)
Fig. 21.12 Drain is placed
in the thorax, trocars are
retrieved with the control
of possible bleeding at the
sites. Expansion of the lungs
follows under direct vision
References
1. Maas KW, Biere SSAY, Scheepers JJG, et al. Minimally Invasive
Intrathoracic anastomosis after Ivor Lewis esophagectomy for
cancer. A review of transoral or transthoracic use of staplers. Surg
Endosc. 2012;26:1795–02.
2. Straatman J, van der Wielen N, Nieuwenhuijzen GAP, et al.
Techniques and short-term outcomes for total minimally invasive
Ivor Lewis esophageal resection in distal esophageal and gastroesophageal junction cancers: pooled data from six European centers.
Surg Endosc. 2017;31:119–26.
Intrathoracic EsophagoGastrostomy After MIE Ivor Lewis
Resection: End-to-Side Anastomosis
Using a Double Endoloop System
Camiel Rosman and Bastiaan Klarenbeek
22
22.1 Description of the Surgical Procedure (See Video 22.1)
The key steps to perform an intrathoracic esophago-gastric
anastomosis using a double Endoloop system are:
Through a right thoracoscopy in prone, we use four tro-
cars. The key steps of the procedure are:
1. The esophagus is divided by means of stapler at the
level of the azygos vein (Fig. 22.1)
2. The stapled line is partially excised (Fig. 22.1)
3. A conventional 28 mm anvil is introduced in the thorax
and afterward in the esophagus (Fig. 22.2)
4. The first endoloop is fasten around the esophagus and
the anvil (Fig. 22.3)
5. The second endoloop is fasten more distally (Fig. 22.4)
6. The remnant stapled line is excised and the excess tis-
sue is trimmed by scissors (Fig. 22.5)
7. The proper place for anastomosis without tension in the
gastric conduit is checked. Consequently, the conduit is
open at the mesenteric side and the 28 mm circular staple inserted (Fig. 22.6)
8. The anvil and the stapler are connected and anastomosis is done (Fig. 22.7)
9. The donuts are checked up (Fig. 22.8)
10. The lateral loop is stapled (Fig. 22.9). The staple line is
reinforced (Fig. 22.10)
11. The anastomosis is covered by an omentum wrap fixed
to the pleura (Fig. 22.11).
12. Anastomosis is drained by a Jackson Pratt drain
(Fig. 22.12).
Electronic supplementary material The online version of this
chapter (https://doi.org/10.1007/978-3-030-55176-6_22) contains
supplementary material, which is available to authorized users.
C. Rosman (*) · B. Klarenbeek
Department of Surgery, Radboudumc Hospital, Nijmegen, The
Netherlands
e-mail: rosman@hotmail.com
© Springer Nature Switzerland AG 2021
M. Asunción Acosta et al. (eds.), Atlas of Minimally Invasive Techniques in Upper Gastrointestinal Surgery,
https://doi.org/10.1007/978-3-030-55176-6_22
181
182 C. Rosman and B. Klarenbeek
Fig. 22.1 Esophagus is stapled at the level of the azygos vein and stapled line is partially excised. Close (a, b) and schematic view (c)
Fig. 22.2 A 28 conventional anvil is introduced into the thorax and inserted in the esophagus. Close (a) and schematic view (b)
18322 Intrathoracic Esophago-Gastrostomy …
184 C. Rosman and B. Klarenbeek
Fig. 22.3 The first endoloop is fastened around the esophagus and the anvil. Close (a, b) and schematic view (c)
Fig. 22.4 A second endoloop is fastened distally of the first around the esophagus (a, b)
18522 Intrathoracic Esophago-Gastrostomy …
Fig. 22.5 Stapled line is excised and the excess tissue trimmed. Close (a, b) and schematic view (c)
186 C. Rosman and B. Klarenbeek
Fig. 22.6 Stapler is inserted into the gastric conduit. Close (a, b) and schematic view (c)