Minimally Invasive Esophagogastrectomy for Esophagogastric Junctional Cancer Hirokazu Noshiro, MD, Yoshihiro Miyasaka, MD, Michiaki Akashi, MD, Hironori.

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Presentation transcript:

Minimally Invasive Esophagogastrectomy for Esophagogastric Junctional Cancer Hirokazu Noshiro, MD, Yoshihiro Miyasaka, MD, Michiaki Akashi, MD, Hironori Iwasaki, MD, Osamu Ikeda, MD, Akihiko Uchiyama, MD The Annals of Thoracic Surgery Volume 93, Issue 1, Pages 214-220 (January 2012) DOI: 10.1016/j.athoracsur.2011.08.031 Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Sites of the trocars for laparoscopic surgery. In the abdomen, a 12-mm blunt trocar is inserted above the umbilicus. Another 4 trocars are inserted into the bilateral subcostal sites and the flank abdominal sites. The Annals of Thoracic Surgery 2012 93, 214-220DOI: (10.1016/j.athoracsur.2011.08.031) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Preparation of the jejunal limb for Roux-en-Y reconstruction. One or more jejunal arteries and veins originating from the superior mesenteric artery and vein should be divided to enable the jejunal limb to be moved to the residual esophagus without any tension. The Annals of Thoracic Surgery 2012 93, 214-220DOI: (10.1016/j.athoracsur.2011.08.031) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Sites of the 4 trocars during the thoracoscopic procedures. In the chest, a 12-mm blunt trocar is inserted in the fifth intercostal space (ICS) on the posterior axillary line. Another 3 trocars are inserted under thoracoscopic control: a 12-mm trocar in the sixth ICS on the scapular angle line, a 12-mm trocar in the eighth ICS behind the posterior axillary line, and a 12-mm trocar in the ninth ICS on the scapular angle line for the thoracoscope. Arabic numerals indicate the number of the ICS. (MA = midaxillary line; PA = posterior axillary line.) The Annals of Thoracic Surgery 2012 93, 214-220DOI: (10.1016/j.athoracsur.2011.08.031) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Intrathoracic side-to-side esophagojejunostomy using a linear stapler. (A) A small incision is made on the left side of the esophageal stump and the antimesenteric side of the Roux jejunal limb, 5 cm from the stump, to make a side-to-side anastomosis. Stapling is between the remnant esophagus and the antimesenteric side of the jejunum. A V-shaped anastomosis is created. (B) The common channel for insertion of a linear stapler was closed by hand suturing. The Annals of Thoracic Surgery 2012 93, 214-220DOI: (10.1016/j.athoracsur.2011.08.031) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions