Novel Intracorporeal Esophagojejunostomy Using Linear Staplers During Laparoscopic Total Gastrectomy: π-Shaped Esophagojejunostomy, 3-in-1 Technique

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Novel Intracorporeal Esophagojejunostomy Using Linear Staplers During Laparoscopic Total Gastrectomy: π-Shaped Esophagojejunostomy, 3-in-1 Technique In Gyu Kwon, MD, Young-Gil Son, MD, Seung Wan Ryu, MD, PhD Journal of the American College of Surgeons Volume 223, Issue 3, Pages e25-e29 (September 2016) DOI: 10.1016/j.jamcollsurg.2016.06.011 Copyright © 2016 American College of Surgeons Terms and Conditions

Figure 1 Port placement. Two 5-mm trocars, two 12-mm trocars, and one 10-mm infraumbilical trocar (for the laparoscope) were inserted. (From: Kwan-Hyun Youn, MEDART, with permission.) Journal of the American College of Surgeons 2016 223, e25-e29DOI: (10.1016/j.jamcollsurg.2016.06.011) Copyright © 2016 American College of Surgeons Terms and Conditions

Figure 2 Operative procedures. (A) After constricting the esophagogastric junction with a nylon band, the distal esophagus was opened on the right side. (B) A 60-mm linear stapler was used to perform a functional end to end esophagojejunostomy without dividing the esophagus and jejunum. (C) Esophageal division, common entry hole closure, and jejunal division were performed with a single 60-mm linear stapler (3-in-1 technique). (D) View of the completed esophagojejunostomy. (From: Kwan-Hyun Youn, MEDART, with permission.) Journal of the American College of Surgeons 2016 223, e25-e29DOI: (10.1016/j.jamcollsurg.2016.06.011) Copyright © 2016 American College of Surgeons Terms and Conditions

Figure 3 Anastomosis area after esophagojejunostomy. This new intracorporeal esophagojejunostomy was named the π-shaped anastomosis based on its shape. After removing the stomach from the jejunum along the red line, the previously formed entry hole can be used as an entry hole for the jejunojejunostomy. When division of the jejunal mesentery was difficult or reduction of tension at the esophagojejunostomy site was required, a small segment of the proximal jejunum was removed with the stomach, along the blue line. (From: Kwan-Hyun Youn, MEDART, with permission.) Journal of the American College of Surgeons 2016 223, e25-e29DOI: (10.1016/j.jamcollsurg.2016.06.011) Copyright © 2016 American College of Surgeons Terms and Conditions

Figure 4 Endoscopic view of the esophagojejunostomy. This view was obtained 6 months after surgery. A round anastomosis was observed. Journal of the American College of Surgeons 2016 223, e25-e29DOI: (10.1016/j.jamcollsurg.2016.06.011) Copyright © 2016 American College of Surgeons Terms and Conditions