Transoral Circular Stapler for Cervical Anastomosis During Esophagectomy

This report describes a transoral circular stapling technique for cervical anastomosis during esophagectomy.

After the gastric conduit is delivered into the neck, the plastic guide of the transoral circular anvil is passed through the mouth and retrieved through a small opening made in the center of the linear cervical esophagus staple line, facilitating the passage of the circular anvil through the mouth into the cervical esophagus. The stapler handle is introduced into the gastric conduit through a gastrotomy created in the excess stomach, the spike is advanced, puncturing the greater curvature of the more distal conduit, connected to the circular anvil, and fired. The excess gastric conduit, including the gastrotomy site, is resected using a linear stapler.

Ten consecutive patients (3 women, 7 men) underwent cervical anastomoses (6 transhiatal and 4 three-incision esophagectomy). Median age was 62 years, median body mass index was 24 kg/m², median blood loss was 350 mL, and median operative time was 285 minutes. Pathology included 2 patients with extensive high-grade dysplasia, 1 with refractory reflux-induced stricture, and 7 with malignancy (adenocarcinoma in 6 and squamous cell carcinoma in 1). All patients had complete esophageal and gastric donuts and were without leak during intraoperative endoscopy. There were no clinical or radiographic anastomotic leaks or strictures and no mortality at 90 days.

Cervical anastomosis with the transoral circular stapler is feasible. The technique is reproducible and results in a consistent and widely patent anastomosis with low leak and stricture rates. Larger studies are warranted to confirm our results.