564.俯卧位胸腔镜手缝食管胃吻合术（两阶段完全微创食管癌切除术）。手术技术

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Diseases of the Esophagus Pub Date : 2024-09-02 DOI:10.1093/dote/doae057.289

Spyridon Davakis, Theodoros Liakakos, Alexandros Charalabopoulos

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Methods This is prospective analysis of consecutive patients that underwent 2-stage totally minimally invasive esophagectomy for esophageal and gastro-esophageal junction Siewert type I-II cancers from the same surgical team, over a period of 6 years and more than 250 consecutive esophagectomies. All operations were identical in terms of patient positioning, lymphadenectomy and type of anastomosis formed. The anastomosis was hand-sewn in prone position, in 2-layers, using barbed sutures, with utilization of 3D-assisted thoracoscopy. Thorough technique and key steps of this anastomotic technique are provided. Results Median operative time was 280 minutes while median suturing time for the esophago-gastric anastomosis was 45 minutes. Anastomosis was thoracoscopic, hand-sewn constructed in prone position in all cases. There was no conversion to open. 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引用次数: 0

摘要

背景微创食管切除术于 2000 年代引入，旨在减少术后肺部和心脏并发症。两阶段完全微创食管切除术包括腹腔镜腹部阶段和胸腔镜胸部阶段。这种方法的限制性步骤是食管-胃吻合术。在此，我们旨在介绍利用三维辅助胸腔镜在俯卧位手工缝合食管-胃吻合术的吻合技术。方法这是一项前瞻性分析，分析对象是同一手术团队在 6 年时间里连续 250 多例食管切除手术中，因食管癌和胃食管交界处 Siewert I-II 型癌症而接受两阶段完全微创食管切除术的患者。所有手术在患者体位、淋巴腺切除和吻合类型方面都完全相同。吻合术在俯卧位进行，使用倒钩缝合线分两层手工缝合，并使用三维辅助胸腔镜。提供了该吻合技术的详细技术和关键步骤。结果手术时间中位数为 280 分钟，食管胃吻合术缝合时间中位数为 45 分钟。所有病例均采用胸腔镜、俯卧位手缝吻合术。无一例转为开放手术。吻合口漏并发症的患者有 6 例（2%）；其中 5 例为 I 型吻合口漏，无需干预；1 例为 II 型吻合口漏，采用胸腔镜灌洗和胸腔引流术治疗，然后进行内VAC治疗。结论食管-胃吻合口的形成是两阶段完全微创食管切除术的限制性步骤。大多数外科医生都喜欢使用机械订书机来完成吻合术。我们的吻合器技术是一种安全有效的吻合器，具有良好的临床效果。它可以安全有效地复制，具有手工吻合的所有优点，并能显著减少术后吻合口漏的破坏性后果。https://wetransfer.com/downloads/bdf3a3496197daf79ccf5b05f71ba64920240309175850/a4da3be742fd3199e102e553c8a4011e20240309175918/c14cc2。

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564. PRONE POSITION THORACOSCOPIC HAND-SEWN ESOPHAGO-GASTRIC ANASTOMOSIS DURING 2-STAGE TOTALLY MINIMALLY INVASIVE ESOPHAGECTOMY FOR CANCER. SURGICAL TECHNIQUE

Background Minimally invasive esophagectomy has been introduced in the 2000s in an effort to reduce post-operative pulmonary and cardiac complications. 2-stage totally minimally invasive esophagectomy combines laparoscopic abdominal phase followed by thoracoscopic thoracic phase. The rate limiting step of this approach is the construction of esophago-gastric anastomosis. Herein, we aim to present our anastomotic technique on hand-sewn esophago-gastric anastomosis in prone position, utilizing 3D-assisted thoracoscopy. Methods This is prospective analysis of consecutive patients that underwent 2-stage totally minimally invasive esophagectomy for esophageal and gastro-esophageal junction Siewert type I-II cancers from the same surgical team, over a period of 6 years and more than 250 consecutive esophagectomies. All operations were identical in terms of patient positioning, lymphadenectomy and type of anastomosis formed. The anastomosis was hand-sewn in prone position, in 2-layers, using barbed sutures, with utilization of 3D-assisted thoracoscopy. Thorough technique and key steps of this anastomotic technique are provided. Results Median operative time was 280 minutes while median suturing time for the esophago-gastric anastomosis was 45 minutes. Anastomosis was thoracoscopic, hand-sewn constructed in prone position in all cases. There was no conversion to open. Anastomotic leak complicated n=6 patients (2%); n=5 were type I anastomotic leaks, requiring no intervention and n=1 was type II, which was treated with thoracoscopic lavage and chest drains followed by endoVAC therapy. Conclusion Formation of the esophago-gastric anastomosis is the rate limiting step of 2-stage totally minimally invasive esophagectomy. Most surgeons prefer the construction utilizing mechanical staplers. Our anastomotic technique, present a safe and effective anastomosis, with favorable clinical outcomes. It can be reproduced safely and effectively, offering all the advantages of manual anastomosis and significant reduction of devastating post-operative anastomotic leakage. https://wetransfer.com/downloads/bdf3a3496197daf79ccf5b05f71ba64920240309175850/a4da3be742fd3199e102e553c8a4011e20240309175918/c14cc2

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