Dept Thorac Cardiovasc Surg PNUSM

2008 대한흉부외과학회 -춘계학술대회

Practical Aspect on VATS EsophagoGastrostomy with circular stapler

Hoseok I, MD, PhD, Young-Dae Kim, MD, PhD, Bong-Soo Son, MD, Sun Hee Kim, MD, Mi-ju Bae, MD, Hyo-Yeong Ahn, MDDepartment of Thoracic and Cardiovascular Surgery Pusan National University School of Medicine

•Minimally Invasive Esophageal Surgery–Benign: enucleation, myotomy, anti-reflux op.

–Malignancy: esophagectomy + reconstruction with stomach•Thoracoscopy Laparoscopy Cervical EGstomy

•Laparoscopy VATS intrathoracic EGstomy–Indication: mid to lower esophageal cancer, C-T1 N0-1 M0

Dept Thorac Cardiovasc Surg PNUSM

2008 대한흉부외과학회 -춘계학술대회

To overcome Practical Aspect on VATS EGstomy with circular stapler• Purse-string suture

hand-sewing

• Anvil insertion: – Short anvil holder:

Skin incisionGauzeLaparoscopic anvil

holder

– Angle Skin incision Laparoscopic anvil

holder

• Body insertion– Short shaft long,

slender – Angle skin incision

• High• Low

– Narrow ICS: Patient’s position: Segmental resection

of rib without injury to intercostal nerve

• Skin incision

Dept Thorac Cardiovasc Surg PNUSM

2008 대한흉부외과학회 -춘계학술대회

Skin incision

① 4th, AAL

② Scapular tip

④ 8-9th, PAL

③7-8th, MAL

⑤ 1mm

① 3rd, AAL

②

Sca

pula

r tip

⑥ 8th, PAL

③6 th, AAL

⑤ 5mm

④ 6 th, MAL

Dept Thorac Cardiovasc Surg PNUSM

2008 대한흉부외과학회 -춘계학술대회

MIES in PNUH

• Hybrid, 3– VATS + laparotomy + cervical anastomosis (2)– Laparotomy + VATS EGstomy (1)

• 57/m, midthoracic eso, squamous cell ca., c-T1 N0-1 M0• p-T1N0M0: mucosa (lamina propria), LN 0/32

• Total MIES, 2– VATS + laparoscopy + cervical anastomosis (1)– Laparoscopy + VATS EGstomy (1)

• 57/m, lower thoracic eso, squamous cell ca., c-T1 N0-1 M0• p-T1N0M0: submucosa, LN 0/20

Dept Thorac Cardiovasc Surg PNUSM

2008 대한흉부외과학회 -춘계학술대회

VATS EGstomy with circular stapler

VIDEO

Dept Thorac Cardiovasc Surg PNUSM

2008 대한흉부외과학회 -춘계학술대회

Postoperative

Dept Thorac Cardiovasc Surg PNUSM

2008 대한흉부외과학회 -춘계학술대회

Thank you for your attention!