A Simple Technique for Performing Laparoscopic Purse-String Suturing During Circular Stapling Anastomosis |
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Authors: | Shuji Takiguchi Mitsugu Sekimoto Yoshiyuki Fujiwara Hiroshi Miyata Takushi Yasuda Yuichiro Doki Masahiko Yano Morito Monden |
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Affiliation: | (1) Department of Surgery and Clinical Oncology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0876, Japan |
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Abstract: | An esophagojejunostomy using a circular stapler requires the fixing of an anvil at the esophageal stump. When this placement procedure is laparoscopically performed, purse-string suturing is difficult, and there is a risk of loosening when a conventional needle driver is used. We herein present a simple but effective technique for performing laparoscopic purse-string suturing of the esophageal stump using a semiautomatic suturing device called the Endostitch. Gastrointestinal anvil placement was laparoscopically performed for 10 patients who underwent an esophagojejunostomy following a total gastrectomy. After the lumen of the esophagus was expanded using bowel forceps, the Endostitch was used to place approximately 12 encircling purse-string sutures. An anvil was positioned with support of the esophageal wall at three points with forceps. The Endostitch was used for the ligation with a sufficient degree of tension applied by extracorporeally pulling the sutures through the abdominal wall. The time for placement of the anvil averaged approximately 8 min. The ring formation following anastomosis was favorable in all patients. As a result, we consider our technique to be simple but very effective. |
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Keywords: | Laparoscopic surgery Gastrectomy Anastomosis |
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