Transorally Inserted Anvil (OrVil) For Digestive Tract Reconstruction Technique During Laparoscopic And Thoracoscopic Esophagectomy

[Objective]To summarize our experience on digestive tract reconstruction by using atransorally placed anvil (OrVil， Covidien) in laparoscopic and thoracoscopicesophagectomy．[Methods]Between December2010and February2012，18patients(15men and3women，mean age57years，ranging from35to68years) underwent laparoscopic andthoracoscopic esophagectomy with OrVil in our hospital．In the patients，the tumorwas located at the middle esophagus in six case，the lower esophagus in twelvecases．The mean length of the tumor was3.7cm(ranged from1.0to5.0cm)．Duringthe operation，we separated the stomach under a laparoscope to form a tube，and then，after removing intra—abdominal lymph nodes，we separated the thoracic esophagus，and resected thoracic lymph nodes．Finally，The anvil (OrVilTM；Covidien，Mansfield，MA，USA) was placed thrasorally and positioned at the esophageal stump．Theesophagastric anastomosis was performed intracorporeally with a circular stapler(EEAXL25Covidien，Mansfield，MA，USA)．[Results]All the procedures were carried out smoothly without converting to opensurgery，or death．The mean operation time in this series was295minutes(rangedfrom215to360minutes)．The mean intraoperative blood loss was148ml(80—200m1)．All the patients received liquid diet in7to15days after the operation．The meanhospital stay was17days(ranged from10to38days)，during which no anastomotic complications occurred，1patients required re-exploration for bleeding．[Conclusions]OrVil system is safe and effective for digestive tract reconstruction in totalthoracoseopic and laparoscopic esophagectomy．...