Thoracoscopic construction of an intrathoracic esophagogastric anastomosis using a circular stapler: transoral placement of the anvil.

PURPOSE: The purpose of this study is to describe a novel technique for thoracoscopic construction of an intrathoracic esophagogastrostomy using a circular stapler.

DESCRIPTION: Conventional method for construction of the esophagogastric anastomosis requires placement of the anvil through an esophageal stump and securing it with a pursestring suture. Advances in stapler technology now permit the anvil to be placed transorally and positioned at the esophageal stump without the need for a pursestring suture.

EVALUATION: Ten patients underwent laparoscopic and thoracoscopic esophagectomy with construction of an intrathoracic esophagogastric anastomosis using a circular stapler technique. The anvil was placed transorally in all patients without difficulty. There were no operative complications or postoperative leaks.

CONCLUSIONS: The transoral placement of the anvil during thoracoscopic construction of an esophagogastrostomy is technically feasible and may facilitate the performance of the esophagogastric anastomosis using a circular stapler.