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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!