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Pursestring Stapled Anastomotic Technique for Minimally Invasive Ivor Lewis Esophagectomy  Ren-Quan Zhang, MD, Wan-Li Xia, MD, Ning-Ning Kang, MD, Wei.

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Presentation on theme: "Pursestring Stapled Anastomotic Technique for Minimally Invasive Ivor Lewis Esophagectomy  Ren-Quan Zhang, MD, Wan-Li Xia, MD, Ning-Ning Kang, MD, Wei."— Presentation transcript:

1 Pursestring Stapled Anastomotic Technique for Minimally Invasive Ivor Lewis Esophagectomy 
Ren-Quan Zhang, MD, Wan-Li Xia, MD, Ning-Ning Kang, MD, Wei Ge, MD, An-Guo Chen, MD, Ke-Chao Zhu, MD  The Annals of Thoracic Surgery  Volume 94, Issue 6, Pages (December 2012) DOI: /j.athoracsur Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 (A) A pursestring (blue) is hand sewn through the muscular layer (grey) of the esophagus, which is 5–8 cm proximal to the esophageal cancer. (B) An incision is made in the esophageal wall 2–3 cm distal to the pursestring. (C) The anvil head is inserted through the incision and pushed above the pursestring. The pursestring is tied, and the transection line (dotted line) is determined. (D) The mucosal (red) and muscular (grey) layers are transected separately, and the stump mucosa is retained 5 mm longer than the adjacent muscular layer. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 A pursestring is hand sewn through the muscular layer of the esophagus with one piece of 3-0 Prolene suture. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 The anvil of the stapler is inserted through the esophageal incision while the incision is held open with three grasping devices. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

5 Fig 4 The esophagus is transected in such a manner that the mucosal layer of the proximal stump is kept 5 mm longer than the adjacent muscular layer. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

6 Fig 5 The side of the gastric conduit is anastomosed to the end of the esophagus by joining the anvil to the stapler. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

7 Fig 6 The anastomosis is embedded by use of the previously reserved 2 cm of mediastinal pleura. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

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