A new method for intrathoracic anastomosis in laparoscopic esophagectomy

The benefits of laparoscopic procedures over the traditional open technique for esophagectomy in the management of esophageal cancer are well documented. A disadvantage of the laparoscopic technique is longer surgery, particularly in the early part of a surgeon's "learning curve." In a two-stage (Ivor-Lewis) procedure, performance of the esophagogastric anastomosis within the chest can be a "rate-limiting step." A circular stapler is used, which requires placement of a purse-string suture or a manually-tied knot around in the transected proximal esophagus to secure the anvil in place. This is technically demanding and time-consuming in the laparoscopic setting. The authors have devised a method that obviates the need for a purse string or knot, simplifying the intrathoracic esophagogastric anastomosis while still achieving a safe anastomosis.