VATS Hand-Sewn Intrathoracic Esophagogastric Anastomosis

<b>Abstract</b><div>Totally 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.</div><div><br><div><p><b>Preference card</b></p><ol><li>5 mm, 30 degree camera</li><li>5 mm endoscopic needle holder</li><li>4-0 polydiaxone (PDS) sutures</li><li>5 mm endoscopic knot pusher</li></ol><p><b>Tricks and Pitfalls</b></p><ol><li>The 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.</li><li>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.</li><li>The corner Connell sutures are important in inverting the mucosal layer before the anterior portion of the anastomosis is performed.</li><li>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.</li></ol><div>The full article is avalable at https://www.ctsnet.org/article/vats-hand-sewn-intrathoracic-esophagogastric-anastomosis</div></div>