Abstract
It is said that laparoscopic esophagoenteral anastomosis is not easy. In particular, purse-string suture of the abdominal esophagus is difficult when using a circular stapler. We have developed an endoscopic purse-string suture instrument, the “Endo-PSI (II)”, and the instrument was employed clinically during laparoscopy-assisted total gastrectomy. The device was inserted into the abdominal cavity through a 4-cm minilaparotomy of the epigastrium, and pneumoperitoneum was established by closing a Lap Disc. The Endo-PSI (II) was attached to the abdominal esophagus and a straight needle with a 2-0 polypropylene suture was passed through the device laparoscopically. After a purse-string suture of the abdominal esophagus was made, the abdominal esophagus was transected laparoscopically and the removed stomach was pulled out through the minilaparotomy. The anvil head of a circular stapler was inserted into the abdominal cavity through the minilaparotomy, and insertion of the anvil into the esophagus and ligation of the purse-string suture were performed laparoscopically, too. The combination of using a circular stapler for esophagojejunostomy and closure of the jejunal stump was also performed laparoscopically. Between May 2007 and May 2008, these products were used in 23 patients during laparoscopy-assisted total gastrectomy. There were no cases that required conversion to a conventional open procedure. The newly developed Endo-PSI (II) was useful for laparoscopic purse-string suture of the esophagus.
Article PDF
Similar content being viewed by others
References
Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Hasumi A. Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymphadenectomy for advanced gastric cancer. Gastric Cancer 1999;2:230–234.
Matsui H, Uyama I, Sugioka A, Fujita J, Komori Y, Ochiai M, et al. Linear stapling forms improved anastomoses during esophagojejunostomy after a total gastrectomy. Am J Surg 2002;184:58–60.
Usui S, Ito K, Hiranuma S, Takiguchi N, Matsumoto A, Iwai T. Hand-Assisted laparoscopic esophagojejunostomy using newly developed purse-string suture instrument “Endo-PSI”. Surg Laparosc Endosc Percutan Tech 2007;17:107–110.
Sobin LH, Wittekind C. International Union Against Cancer: TNM classification of malignant tumors. 5th ed. New York: Wiley-Liss; 1997:59–62.
Usui S, Inoue H, Yoshida T, Fukami N, Kudo SE, Iwai T. Handassisted laparoscopic total gastrectomy for early gastric cancer. Surg Laparosc Endosc Percutan Tech 2003;13:304–307.
Parker J, Sell H, Stahlfeld K. A new technique for esophagojejunostomy after total gastrectomy for gastric cancer. Am J Ssurg 2001;182:174–176.
Hiki N, Fukunaga T, Yamaguchi T, Nunobe S, Tokunoga M, Ohyama S, et al. Laparoscopic esophagogastric circular stapled anastomosis: a modified technique to protect the esophagus. Gastric Cancer 2007;10:181–186.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Usui, S., Nagai, K., Hiranuma, S. et al. Laparoscopy-assisted esophagoenteral anastomosis using endoscopic purse-string suture instrument “Endo-PSI (II)” and circular stapler. Gastric Cancer 11, 233–237 (2008). https://doi.org/10.1007/s10120-008-0481-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10120-008-0481-8