Reconstruction of the Gastrointestinal Tract byhemi-doublestapling Method for the Esophagus andjejunum Using Eea Orvil in Laparoscopic Total Gastrectomy and Proximal Gastrectomy

Abstract: We report the method of anastomosis based on a hemi-double stapling technique (hereinafter, HDST) using a trans-oralanvil delivery system (EEA TM OrVil TM ) for reconstructing theesophagus and lifted jejunum following laparoscopic total gas-trectomy or proximal gastric resection. As a basic technique, end-to-side anastomosis was used for the cut-off stump of theesophagus and lifted jejunum. After the gastric lymph nodedissection, the esophagus was cut off obliquely to the long axisusing an automated stapler. EEA TM OrVil TM was orally, and asmall hole was created at the tip of the obliquely cut-off stump withscissors to let the valve tip pass through. When it was confirmedthat the automated stapler and center rod were made completelylinear, the anvil and the main unit were connected with each otherand firing was carried out. Then, HDST-based anastomosis wascompleted. The method may safe laparoscopic anastomosis be-tween the esophagus and reconstructed intestine.Key Words: esophagojejunostomy, hemi-double stapling method,EEA OrVil, laparoscopic surgery