Minimally Invasive Esophagectomy with the Transoral EEA Stapler: Part II
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The author begins with four 5 mm ports and intrathoracic CO2 insufflation. The esophagus is dissected and lymph nodes resected above the level of the azygous vein. The linear stapler is used to transect the esophagus, and the transoral EEA™ Stapler is positioned through the staple line. The posterior inferior incision is enlarged, the other half of the EEA™ Stapler is placed through a gastrotomy, and the stapler ends are mated. The residual gastrotomy and gastric margin is resected, and the stapled circular anastomosis is oversewn with interrupted sutures. Without oversewing, this device is associated with a high leak rate. When sewing over the anastomosis, one of the remaining 5 mm ports is enlarged to allow passage of a curved needle. This is strategically chosen at the time depending on the location of the port sites relative to the location of the anastomosis. During this and the previous dissection, the 30-degree 5 mm camera is often moved from one port site to another to maximize the operative view.
View Part I here.