Thoracoscopic oesophagectomy with intrathoracal stapled anastomosis.

Techniques for intrathoracal stapler anastomosis under thoracoscopic control were studied and developed in an experimental program. Since this procedure is possible from two directions, both directions were evaluated. Two different techniques, a transoral and a transhiatal, resulted. For the transoral technique the stapler is inserted from above. The anvil, which is connected to a wire, is drawn into the abdomen together with the distal oesophagus. Retracting the wire pulls both the anvil and the stomach tube up into the thorax after the insertion of the anvil. The second technique requires a special attachment to introduce the anvil transhiatally into the thorax and into the oesophageal stump. The gastric tube is pushed into the thorax by the stapler gun, which is inserted into the stomach through an antrostomy. The insertion of the anvil into the oesophageal stump can also be achieved with the support of a flexible endoscope including a polyp snare.