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Feasibility of a High Intrathoracic Esophagogastric Anastomosis Without Thoracic Access After Laparoscopic-Assisted Transhiatal Esophagectomy: A Pilot Experimental Study

Department of Surgery, 1st Surgical Clinic, "Iuliu Hatieganu," University of Medicine and Pharmacy, Cluj-Napoca, Romania, vabintintan{at}yahoo.com, Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany

Arianeb Mehrabi, MD

Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany

Hamidreza Fonouni, MD

Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany

Majid Esmaeilzadeh, MD

Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany

Beat P. Müller-Stich, MD

Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany

Gheorghe Funariu, MD

Department of Surgery, 1st Surgical Clinic, "Iuliu Hatieganu," University of Medicine and Pharmacy, Cluj-Napoca, Romania

Constantin Ciuce, MD

Department of Surgery, 1st Surgical Clinic, "Iuliu Hatieganu," University of Medicine and Pharmacy, Cluj-Napoca, Romania

Carsten N. Gutt, MD

Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany

Introduction. The aim of the present study was to evaluate the feasibility of a technique that uses solely the transhiatal approach to create a high intrathoracic esophagogastric anastomosis after laparoscopic transhiatal resection of the distal esophagus. Method. Using a laparoscopic approach, the esophagi of 10 midsized pigs were dissected and transected as high as possible in the thorax, and the anvil of a circular stapler was introduced perorally into the esophageal stump. Through a midline short laparotomy, the circular stapler was inserted into the gastric tube and advanced through the hiatus to be connected with the anvil and create the anastomosis. Results. Development of the technique was completed within the first 6 experiments. The last 4 operations were entirely successful, standardized, and easily reproducible. Conclusion. The technique is feasible in this experimental setting. Further studies are required to establish if there is a clinical role for this technique in esophageal surgery.

Key Words: transhiatal esophagectomy • laparoscopic esophagectomy • laparoscopic distal esophagectomy • minimally invasive esophagectomy • intrathoracic esophagogastric anastomosis

This version was published on September 1, 2009

Surgical Innovation, Vol. 16, No. 3, 228-236 (2009)
DOI: 10.1177/1553350609345852


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