1. 2008 대한흉부외과학회 - 춘계학술대회 Dept Thorac Cardiovasc Surg PNUSM Practical Aspect on VATS EsophagoGastrostomy with circular stapler Hoseok I, MD, PhD, Young-Dae Kim, MD, PhD, Bong-Soo Son, MD, Sun Hee Kim, MD, Mi-ju Bae, MD, Hyo-Yeong Ahn, MD Department of Thoracic and Cardiovascular Surgery Pusan National University School of Medicine Minimally Invasive Esophageal Surgery –Benign: enucleation, myotomy, anti-reflux op. –Malignancy: esophagectomy + reconstruction with stomach Thoracoscopy  Laparoscopy  Cervical EGstomy Laparoscopy  VATS intrathoracic EGstomy –Indication: mid to lower esophageal cancer, C-T1 N0-1 M0

2. 2008 대한흉부외과학회 - 춘계학술대회 Dept Thorac Cardiovasc Surg PNUSM To overcome Practical Aspect on VATS EGstomy with circular stapler Purse-string suture –  hand-sewing Anvil insertion: –Short anvil holder:  Skin incision  Gauze  Laparoscopic anvil holder –Angle  Skin incision  Laparoscopic anvil holder Body insertion –Short shaft  long, slender –Angle  skin incision High Low –Narrow ICS:  Patient’s position:  Segmental resection of rib without injury to intercostal nerve Skin incision

3. 2008 대한흉부외과학회 - 춘계학술대회 Dept Thorac Cardiovasc Surg PNUSM Skin incision ① 4 th, AAL ② Scapular tip ④ 8-9 th, PAL ③ 7-8 th, MAL ⑤ 1mm ① 3 rd, AAL ② Scapular tip ⑥ 8 th, PAL ③ 6 th, AAL ⑤ 5mm ④ 6 th, MAL

4. 2008 대한흉부외과학회 - 춘계학술대회 Dept Thorac Cardiovasc Surg PNUSM MIES in PNUH Hybrid, 3 –VATS + laparotomy + cervical anastomosis (2) –Laparotomy + VATS EGstomy (1) 57/m, midthoracic eso, squamous cell ca., c-T1 N0-1 M0 p-T1N0M0: mucosa (lamina propria), LN 0/32 Total MIES, 2 –VATS + laparoscopy + cervical anastomosis (1) –Laparoscopy + VATS EGstomy (1) 57/m, lower thoracic eso, squamous cell ca., c-T1 N0-1 M0 p-T1N0M0: submucosa, LN 0/20

5. 2008 대한흉부외과학회 - 춘계학술대회 Dept Thorac Cardiovasc Surg PNUSM VATS EGstomy with circular stapler VIDEO

6. 2008 대한흉부외과학회 - 춘계학술대회 Dept Thorac Cardiovasc Surg PNUSM Postoperative

7. 2008 대한흉부외과학회 - 춘계학술대회 Dept Thorac Cardiovasc Surg PNUSM Thank you for your attention!