HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Heitmiller, R. F. Search for Related Content PubMed PubMed Citation Articles by Heitmiller, R. F. Related Collections Esophagus - other Related Article

---

New Technology

Invited Commentary

Department of Surgery, Union Memorial Hospital, Suite 610, J.P.B., 3333 N Calvert St, Baltimore, MD 21218-2895

(Email: richard.heitmiller{at}medstar.net).

Techniques and outcomes for minimally invasive esophageal surgery continue to challenge results reported for open methods. In this article by Nguyen and colleagues [1], the authors describe a method for circular stapled esophagogastric anastomosis that passes the anvil transorally instead of thoracoscopically, thereby avoiding a technically difficult and time-consuming step in the anastomotic process. In their early experience with 10 patients, this new approach was successful in all patients with no anastomotic leaks.

This work continues to advance the technical options for minimally invasive esophageal resections; in addition, it underscores two points. The first point is the importance of translational clinical applications. Circular stapling devices, originally designed for low rectal anastomoses, found application in laparoscopic bariatric surgery, and now that experience is translated to post-esophagectomy reconstructive anastomoses. Experience with transoral anvil insertion from bariatric surgery identified the importance of a tilted head to facilitate oral passage of the anvil. This experience has now been applied to esophageal surgery. The second point is the beneficial inter-relationship between the surgeon and product manufacturer, especially for minimally invasive surgery. Responding to a specific clinical need, a pre-tilted device has been created to specifically permit transoral anvil insertion to minimize posterior pharyngeal injury.

As it often happens, solving one problem raises other potential concerns. Whereas the technique described avoids transthoracic anvil insertion, it does create a circular staple line that crosses the transverse staple line of the proximal esophageal stump. Crossed staple lines have historically increased the risk of anastomotic leakage and stricture formation. The authors' early results with 10 patients do not suggest that this will be a problem, but further clinical results are needed to further validate this interesting method.

	References

Top References

 

1. Nguyen NT, Hinojosa MW, Smith BR, Gray J, Reavisc KM. Thoracoscopic construction of an intrathoracic esophagogastric anastomosis using a circular stapler: transoral placement of the anvil Ann Thorac Surg 2008;86:989-993.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Heitmiller, R. F. Search for Related Content PubMed PubMed Citation Articles by Heitmiller, R. F. Related Collections Esophagus - other Related Article