Thoracoscopic Construction of an Intrathoracic Esophagogastric Anastomosis Using a Circular Stapler: Transoral Placement of the Anvil Ninh T. Nguyen,

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Presentation transcript:

Thoracoscopic Construction of an Intrathoracic Esophagogastric Anastomosis Using a Circular Stapler: Transoral Placement of the Anvil Ninh T. Nguyen, MD, FACS, Marcelo W. Hinojosa, MD, Brian R. Smith, MD, James Gray, BS, Kevin M. Reavis, MD The Annals of Thoracic Surgery Volume 86, Issue 3, Pages 989-992 (September 2008) DOI: 10.1016/j.athoracsur.2008.03.034 Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Thoracoscopic construction of an intrathoracic esophagogastric anastomosis using a circular stapler, with the 25-mm anvil placed transthoracically through the esophageal stump and secured with a pursestring suture. The Annals of Thoracic Surgery 2008 86, 989-992DOI: (10.1016/j.athoracsur.2008.03.034) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Thoracoscopic view showing the transected esophageal stump using a 60-mm linear stapler at the level of the azygous vein. The Annals of Thoracic Surgery 2008 86, 989-992DOI: (10.1016/j.athoracsur.2008.03.034) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The Orvil (Autosuture, Norwalk, CT) is being placed transorally in preparation for construction of an intrathoracic esophagogastric anastomosis using a circular stapler. The Annals of Thoracic Surgery 2008 86, 989-992DOI: (10.1016/j.athoracsur.2008.03.034) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 An esophagotomy is performed perpendicular to the esophageal stump staple line in preparation for retrieval of the oral-gastric tube with the attached anvil. The Annals of Thoracic Surgery 2008 86, 989-992DOI: (10.1016/j.athoracsur.2008.03.034) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 The oral-gastric tube is advanced through the esophagotomy of the esophageal stump and removed through one of the thoracoscopic ports. The Annals of Thoracic Surgery 2008 86, 989-992DOI: (10.1016/j.athoracsur.2008.03.034) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 The anvil is pulled transorally and positioned within the esophageal stump. The Annals of Thoracic Surgery 2008 86, 989-992DOI: (10.1016/j.athoracsur.2008.03.034) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 The complete positioning of the transoral anvil after removal of the oral-gastric tube. The Annals of Thoracic Surgery 2008 86, 989-992DOI: (10.1016/j.athoracsur.2008.03.034) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions