Novel Esophago-Jejunal Anastomosis Method During Totally Laparoscopic Total Gastrectomy

Novel Esophago-Jejunal Anastomosis Method During Totally Laparoscopic Total Gastrectomy: π-shape Esophagojejunostomy, Three-in-one Technique

Laparoscopic gastrectomy became a good option for early gastric cancer. Surgical trend is gradually changed to totally laparoscopic gastrectomy from laparoscopy-assisted gastrectomy requiring mini-laparotomy. Various types of intracorporeal anastomosis have been introduced for esophagojejunostomy during total gastrectomy. We invented a novel anastomosis method using linear stapler for total gastrectomy. Three procedures (Jejunal resection, esophageal resection and closure of common entry hole after anastomosis) was performed with only one stapler. Therefore, the novel method is simple and fast. Also, this new technique is better economically than previously introduced anastomosis using linear stapler because lesser number of stapler is required. We want to demonstrate the feasibility of novel intracorporeal anastomosis method during laparoscopic total gastrectomy.

Inclusion Criteria:

• Histologically confirmed adenocarcinoma in stomach
• Males or Females, aged≥20 years and ≤80 years
• Without serosa invasion, extraperigastric lymph node metastasis and other organ metastasis stage in preoperative evaluation, (cT1-3N0-1M0)
• Beyond the indication of ESD
• Tumor location in high body of stomach or requiring total gastrectomy
• Eastern Cooperative Oncology Group Performance Status (ECOG PS) of 0 or 1 at study entry
• American Society of Anesthesiolosists (ASA) score of 1 to 3
• The patient has given their written informed consent to participate in the study

Exclusion Criteria:

• Simultaneous malignancy in other organ
• Experience of previous laparotomy
• Experience of gastric resection including wedge resection
• Vulnerable subject