scholarly journals V-OG01 Minimally invasive oesophagectomy: Technique of linear stapled anastomosis

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Benjamin Knight
Keyword(s):  
Minimally Invasive ◽  
Stapled Anastomosis ◽  
Leak Rate ◽  
Stricture Rate ◽  
Low Residue Diet ◽  
Key Steps ◽  
Minimally Invasive Oesophagectomy ◽  
Omental Fat ◽  
Linear Stapled Anastomosis ◽  
Anastomotic Techniques

Abstract Background Several anastomotic techniques have been described when performing an oesophagectomy. Each technique has its own merits and drawbacks. The stapled side to side technique creates a widely patent anastomosis with low stricture rate. Methods This video highlights the technique adopted and developed over the last 5 years. There are several key steps that need to be adhered to, to create a reliable, robust and reproducible anastomosis. These include the orientation of the oesophagus during transection, the use of mucosal retaining sutures, the use of a 34 bougie for the oesophagotomy and the correct retraction of the conduit when performing the anastomosis. Results The anastomosis was successfully performed without complications. Check endoscopy revealed a widely patent secure join. The anastomosis typically now takes 15–18 minutes. At the end of the procedure, the conduit cap was buried under the pleura and the anastomosis wrapped in omental fat. The patient was discharged on day 10 on a low residue diet. Conclusions This technique has been adopted and developed over the last 5 years. It has proved reliable and reproducible with a low stricture rate and a very low leak rate. It is easier to perform than a total hand sewn anastomosis and permits visualisation of the luminal oesophagus prior to anastomosis.

scholarly journals Totally mechanical linear stapled anastomosis for minimally invasive Ivor Lewis esophagectomy: Operative technique and short‐term outcomes

2020 ◽  
Vol 11 (3) ◽  
pp. 769-776 ◽  
Author(s):  
Hui‐Jiang Gao ◽  
Ju‐Wei Mu ◽  
Wei‐Min Pan ◽  
Malcolm Brock ◽  
Mao‐Long Wang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Operative Technique ◽  
Stapled Anastomosis ◽  
Short Term ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Linear Stapled Anastomosis

scholarly journals Minimally Invasive Versus open AbdominoThoracic Esophagectomy (MIVATE) - study protocol for a randomized controlled trial DRKS00016773

2020 ◽  
Author(s):  
Felix Nickel ◽  
Pascal Probst ◽  
Alexander Studier-Fischer ◽  
Henrik Nienhüser ◽  
Jana Pauly ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Minimally Invasive ◽  
Fast Track ◽  
Postoperative Morbidity ◽  
Controlled Trial ◽  
Stapled Anastomosis ◽  
Randomized Controlled ◽  
Estimated Blood Loss ◽  
Eortc Qlq ◽  
Linear Stapled Anastomosis

Abstract Background: The only curative treatment for most esophageal cancers is radical esophagectomy. Minimally invasive esophagectomy (MIE) aims to reduce postoperative morbidity, but is not yet widely established. Linear stapled anastomosis is a promising technique for MIE because it is quite feasible even without robotic assistance. Aim of the present study is to compare total MIE with linear stapled anastomosis to open esophagectomy (OE) with circular stapled anastomosis with special regard to postoperative morbidity in an expertise-based randomized controlled trial (RCT). Methods/design: This superiority RCT compares MIE with linear stapled anastomosis (intervention) to OE with circular stapled anastomosis (control) for Ivor-Lewis esophagectomy. It was initiated in February 2019 and recruitment is expected to last for 3 years. For inclusion, patients must be 18 years of age or more with a resectable primary malignancy in the distal esophagus. Participants with tumor localizations above the azygos vein, metastasis or infiltration into adjacent tissue will be excluded. In an expertise-based approach the allocated treatment will only be carried out by the single most experienced surgeon of the surgical center for each respective technique. The sample size was calculated with 20 participants per group for the primary endpoint postoperative morbidity according to comprehensive complication index (CCI) within 30 postoperative days. Secondary endpoints include anastomotic insufficiency, pulmonary complications, other intra- and postoperative outcome parameters such as estimated blood loss, operative time, length of stay, short-term oncologic endpoints, adherence to a standardized fast-track protocol, postoperative pain, and postoperative recovery (QoR-15). Quality of life (SF-36, CAT EORTC QLQ-C30, CAT EORTC QLQ-OES18) and oncological outcomes are evaluated with 60 months follow-up. Discussion: MIVATE is the first RCT to compare OE with circular stapled anastomosis to total MIE with linear stapled anastomosis exclusively for intrathoracic anastomosis. The expertise-based approach limits bias due to heterogeneity of surgical expertise. The use of a dedicated fast-track protocol in both OE and MIE will shed light on the role of the access strategy alone in this setting. The findings of this study will serve to define which approach has the best perioperative outcome for patients requiring esophagectomy. Trial registration: German Clinical Trials Register DRKS00016773. Registered on February 18th, 2019.

scholarly journals Minimally Invasive Versus open AbdominoThoracic Esophagectomy for esophageal carcinoma (MIVATE) - study protocol for a randomized controlled trial DRKS00016773

2020 ◽  
Author(s):  
Felix Nickel ◽  
Pascal Probst ◽  
Alexander Studier-Fischer ◽  
Henrik Nienhüser ◽  
Jana Pauly ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Minimally Invasive ◽  
Fast Track ◽  
Postoperative Morbidity ◽  
Controlled Trial ◽  
Stapled Anastomosis ◽  
Randomized Controlled ◽  
Estimated Blood Loss ◽  
Eortc Qlq ◽  
Linear Stapled Anastomosis

Abstract Background:The only curative treatment for most esophageal cancers is radical esophagectomy. Minimally invasive esophagectomy (MIE) aims to reduce postoperative morbidity, but is not yet widely established. Linear stapled anastomosis is a promising technique for MIE because it is quite feasible even without robotic assistance. Aim of the present study is to compare total MIE with linear stapled anastomosis to open esophagectomy (OE) with circular stapled anastomosis with special regard to postoperative morbidity in an expertise-based randomized controlled trial (RCT).Methods/design:This superiority RCT compares MIE with linear stapled anastomosis (intervention) to OE with circular stapled anastomosis (control) for Ivor-Lewis esophagectomy. It was initiated in February 2019 and recruitment is expected to last for 3 years. For inclusion, patients must be 18 years of age or more with a resectable primary malignancy in the distal esophagus. Participants with tumor localizations above the azygos vein, metastasis or infiltration into adjacent tissue will be excluded. In an expertise-based approach the allocated treatment will only be carried out by the single most experienced surgeon of the surgical center for each respective technique. The sample size was calculated with 20 participants per group for the primary endpoint postoperative morbidity according to comprehensive complication index (CCI) within 30 postoperative days. Secondary endpoints include anastomotic insufficiency, pulmonary complications, other intra- and postoperative outcome parameters such as estimated blood loss, operative time, length of stay, short-term oncologic endpoints, adherence to a standardized fast-track protocol, postoperative pain, and postoperative recovery (QoR-15). Quality of life (SF-36, CAT EORTC QLQ-C30, CAT EORTC QLQ-OES18) and oncological outcomes are evaluated with 60 months follow-up.Discussion:MIVATE is the first RCT to compare OE with circular stapled anastomosis to total MIE with linear stapled anastomosis exclusively for intrathoracic anastomosis. The expertise-based approach limits bias due to heterogeneity of surgical expertise. The use of a dedicated fast-track protocol in both OE and MIE will shed light on the role of the access strategy alone in this setting. The findings of this study will serve to define which approach has the best perioperative outcome for patients requiring esophagectomy.Trial registration: German Clinical Trials Register DRKS00016773. Registered on February 18th, 2019.

Minimally Invasive Ivor Lewis Esophagectomy with Linear Stapled Anastomosis Associated with Low Leak and Stricture Rates

2019 ◽  
Vol 24 (8) ◽  
pp. 1729-1735 ◽  
Author(s):  
Moshim Kukar ◽  
Kfir Ben-David ◽  
June S. Peng ◽  
Kristopher Attwood ◽  
Ryan M. Thomas ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Stapled Anastomosis ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Linear Stapled Anastomosis

W1516 A Safe and Reproducible Anastomotic Technique for Minimally Invasive Ivor Lewis Esophagectomy – the Circular Stapled Anastomosis with the Transoral Anvil.

2009 ◽  
Vol 136 (5) ◽  
pp. A-929
Author(s):  
Rene Ramirez ◽  
Jessica K. Smith ◽  
Sofia Peeva ◽  
Garrett R. Roll ◽  
Pierre Theodore ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Stapled Anastomosis ◽  
Ivor Lewis ◽  
Anastomotic Technique ◽  
Ivor Lewis Esophagectomy

PS01.212: OUTCOMES OF HYBRID VERSUS FULLY MINIMALLY INVASIVE 2-STAGE ESOPHAGECTOMY FOR CANCER OF THE DISTAL ESOPHAGUS AND GASTRO-ESOPHAGEAL JUNCTION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 110-110
Author(s):  
Kanatheepan Shanmuganathan ◽  
Temisanren Akitikori ◽  
Oluwasunmisola Soile ◽  
Aadil Hussain ◽  
Neda Farhangmehr ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Minimally Invasive ◽  
Anastomotic Leak ◽  
Minimally Invasive Esophagectomy ◽  
Hospital Length ◽  
Leak Rate ◽  
Hospital Length Of Stay ◽  
Cardiac Complications ◽  
Invasive Esophagectomy ◽  
Anastomotic Leak Rate

Abstract Background Esophagectomy is associated with high complication rate and mortality. Numerous approaches have been introduced over the last two decades, with the ambition of reducing rate of complications, morbidity and mortality. Two-stage minimally invasive esophagectomies include hybrid (laparoscopic/thoracotomic) and fully minimally invasive and have recently gained popularity in the treatment of distal esophageal and gastro-esophageal junction cancer. We aim to compare the short-term outcomes between 2-stage hybrid and fully minimally invasive esophagectomy with intrathoracic hand-sewn anastomosis. Methods A retrospective analysis of a 4-year period prospectively collected data of 100 consecutive 2-stage minimally invasive esophagectomies was conducted. All operations were performed in a UK tertiary centre by a single surgical team between 2014 and 2018. All 3-stage and open esophagectomies were excluded from the study. A comparison of anastomotic leak rate, ITU length of stay, hospital length of stay, pulmonary complications, cardiac complications and 30 and 90-day mortality rates was made. Statistical analysis was performed using Graph-Prism 7.04. Results Seventy patients underwent hybrid and 30 underwent fully minimally invasive esophagectomy with intra-thoracic manual anastomosis. Chest infection and anastomotic leak rate were higher in the hybrid group (21.4% vs 16.8% and 10% vs 3.3%); however, cardiac complications were two times more common in fully minimally invasive compared to hybrid esophagectomies (3.3% vs 1.4%). Fully minimally invasive esophagectomies were associated with a shorter ITU stay as well as hospital length of stay compared to hybrid esophagectomies (5.5 vs 6.2 days, P = 0.47 and 10.5 vs 15.6 days P = 0.0018). Complete tumour resection (R0) rate was slightly higher in hybrid compared to fully minimally invasive esophagectomies (70.8% vs 64.3%). Thirty and 90-day mortality rate was 6.67% (1 cardiac and 1 respiratory arrest) in fully minimally invasive and 1.43% in hybrid esophagectomies. None of the mortality cases were related to surgical complications like anastomotic leak or conduit necrosis. Conclusion In our study 2-stage fully minimally invasive esophagectomy is associated with reduced post-operative complication rates compared to 2-stage hybrid oesophagectomy. Further larger studies are needed to assess the 30- and 90-day mortality risk associated with both procedures. Disclosure All authors have declared no conflicts of interest.

PS01.211: IMPLEMENTATION OF A TOTALLY MINIMALLY INVASIVE OESOPHAGECTOMY PROGRAMME IN A UK SPECIALIST CENTRE: INITIAL EXPERIENCE AND OUTCOMES

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 109-110
Author(s):  
Temisanren Akitikori ◽  
Bruno Lorenzi ◽  
Kanatheepan Shanmuganathan ◽  
Oluwasunmisola Soile ◽  
Aadil Hussain ◽  
...  
Keyword(s):  
Lymph Node ◽  
Minimally Invasive ◽  
Conflicts Of Interest ◽  
High Volume ◽  
Pulmonary Complications ◽  
Cardiac Complications ◽  
Initial Experience ◽  
Chyle Leak ◽  
Anastomotic Strictures ◽  
Minimally Invasive Oesophagectomy

Abstract Background Totally minimally invasive oesophagectomy although challenging to perform has garnered popularity in the surgical treatment of oesophageal cancer. Advanced laparoscopic surgical skills are needed with the construction of the intra-thoracic anastomosis in the case of a 2-stage procedure being the rate-limiting step. We aim to report our initial experience and short-term outcomes of totally minimally invasive 3-stage and 2-stage oesophagectomies for cancer. Methods From January 2016 when the minimally invasive oesophagectomy programme was implemented in our Unit, to December 2017, 65 consecutive cases underwent either a 2-stage or a 3-stage oesophagectomy for cancer. In all cases a radical 2-field lymph node dissection was performed. All were performed in a prone position and in the 3-stage oesophagectomies, superior mediastinal lympadenectomy was additionally performed. In the 2-stage cases an end-to-side esophago-gastric anastomosis was constructed in two layers with barbed knotless suture (V-LocTM). Results Male: female was 4:1 with a mean age of 66.44 years (IQR, 43–82). n = 53 were 2-stage and 12 were 3-stage oesophagectomies. Thirty five (53.8%) had neoadjuvant chemotherapy and 30(46.2%) went straight to surgery. There were no open conversions. No feeding jejunostomies were placed routinely. Complete resection (R0) rate was 61.54% (40/65) with a mean lymph node harvest of 28 (IQR, 11–68). Five (7.6%) anastomotic leaks were diagnosed (4 in 2-stage and 1 in 3-stage oesophagectomies), with 1(1.5%) of them (in the 2-stage group) being subclinical requiring no intervention. Furthermore, 1(1.5%) chyle leak and 1(1.5%) gastric staple line leak were also observed. Pulmonary complications were reported in 13.8% of cases and cardiac complications arose in 1.5%. Seven (10.8%) anastomotic strictures were also noted that were treated with endoscopic balloon dilatation. Mean hospital stay was 13 days and 30-day mortality rate was 4.62%. Conclusion Implementation of a minimally invasive oesophagectomy program in our high-volume tertiary centre is yielding good initial results. Vast previous experience in the field is of paramount importance. Hand-sewn intrathoracic anastomosis during 2-stage procedures is feasible and with repetitively good outcomes. Disclosure All authors have declared no conflicts of interest.

O181 SERUM C-REACTIVE PROTEIN CAN BE AN EARLY PREDICTOR OF LENGHT OF HOSPITAL STAY AFTER MINIMALLY INVASIVE OESOPHAGECTOMY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Gabriele Corsi ◽  
Krashna Patel ◽  
Omar Abbassi ◽  
Zobia Gudkalli ◽  
David O’Hara ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Acute Phase Protein ◽  
C Reactive Protein ◽  
Operative Morbidity ◽  
Reactive Protein ◽  
Operative Recovery ◽  
Minimally Invasive Oesophagectomy ◽  
Overall Mortality

Abstract Aim Oesophagectomy is associated with a significant number of potential complications affecting the lenght of the post-operative recovery. Serum C-reactive protein (CRP) is an acute phase protein which has been linked to early detection of post-operative complications, including but not limited to anastomotic leak. The aim of this retrospective study was to investigate the value of CRP elevation in the early post-operative days as a predictor of lenght of Hospital stay after minimally invasive oesophagectomy for cancer. Background and Methods The study group included 88 patients undergoing minimally invasive oesophagectomy for cancer from September 2017 to April 2019. CRP values on post-operative day 1,3,5 and 7 were retrieved and correlated to overall lenght of stay. Post-operative morbidity and mortality were also recorded. Results The approach was fully minimally invasive in 65 patients (74%) and hybrid in the remaining 23 (26%). The median length of stay was 11 days (IQR, 6-105 days) with overall mortality of 3.4% (n=3). Gastro-intestinal complications occurred in 15 patients (17%). The overall surgical or endoscopic re-intervention rate was 13.6% (n=12). The median CRP value was 54.8, 167, 143 and 134 mg/L, respectively on day 1,3,5 and 7. There was a positive correlation between CRP and length of stay on day 1, 3 and 7. A cut-off value of 167 mg/L on day 3 appeared to be a significant predictor of increased lenght of stay (12.8 vs 23.3 days, p=0.008). Conclusion CRP levels above 167mg/L on post-operative day 3 were associated with a prolonged lenght of hospital stay in our group of patients. Elevated CRP in the early post-operative period could represent a useful tool to predict lenght of stay after minimally invasive oesophagectomy.

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