VATS Hand-Sewn Intrathoracic Esophagogastric Anastomosis

AbstractTotally
endoscopic two-stage esophagectomy for carcinoma of the esophagus is a
well-established procedure. There are currently many methods to perform the
intrathoracic esophagogastric anastomosis by video-assisted thoracoscopic
surgery (VATS). This article describes an entirely hand-sewn VATS intrathoracic
esophagogastric anastomosis technique in a 64-year-old woman with a T2N0M0 adenocarcinoma
of the lower third of the esophagus.Preference card5 mm, 30 degree camera5 mm endoscopic needle holder4-0 polydiaxone (PDS) sutures5 mm endoscopic knot pusherTricks and PitfallsThe first layer of seromuscular-anchoring sutures between the posterior wall of the esophagus and stomach are important for alleviating tension on the anastomosis and for proper alignment of the anastomosis without torsion.It is important to perform a circumferential myotomy on the esophagus first and then to cut the mucosal layer long. This ensures the mucosal layer is longer than the muscle layer, prevents retraction of the mucosa into the esophagus, and allows for an accurate mucosal-to-mucosal anastomosis.The corner Connell sutures are important in inverting the mucosal layer before the anterior portion of the anastomosis is performed.It is mandatory to put port B in the third intercostal space. This gives direct perpendicular access to sewing of both ends. Removing the specimen by enlarging this incision facilitates sewing and tying.The full article is avalable at https://www.ctsnet.org/article/vats-hand-sewn-intrathoracic-esophagogastric-anastomosis

胸腔镜两阶段食管切除术是一种成熟的手术方法。目前，有多种方法通过视频辅助胸腔镜手术（VATS）进行胸腔内食管胃吻合。本文介绍了一种在64岁女性患者身上实施的完全手工缝合VATS胸腔内食管胃吻合技术，该患者患有T2N0M0下三分之一食管腺癌。在吻合过程中，首先进行食管周围肌层切开，然后切开黏膜层，确保黏膜层长于肌层，以防止黏膜层回缩至食管，并允许进行准确的黏膜对黏膜吻合。在吻合前部进行角部Connell缝合对于翻转黏膜层至关重要。将B孔置于第三肋间隙是强制性的，这为缝合两端提供了直接的垂直通道。通过扩大此切口取出标本，便于缝合和打结。完整文章可在https://www.ctsnet.org/article/vats-hand-sewn-intrathoracic-esophagogastric-anastomosis查阅。