Robotic Proximal Gastrectomy and Lower Esophagectomy with Intra-Thoracic Esophagogastrostomy Using Open-Door Technique for Esophagogastric Junction Cancer

Kei Hosoda, MD, FACS

Product Details
Product ID: ACS-6044
Year Produced: 2020
Length: 11 min.


The dexterity of robotic surgery provides precise dissection of lymph-nodes and accurate suturing for anastomosis, which results in the lower rate of postoperative complications. We have applied this modality to the surgery for esophagogastric junction cancer to improve postoperative outcomes. We will present this technique. After dissecting the regional lymph-nodes, we cut the esophagus under the guidance of esophagogastroscopy to secure the oral cancer-free margin of the tumor. Through a 4-cm upper midline incision, stomach with lower esophagus was pulled out and was transected. A 2.5cm-wide and 3.5cm-long window with seromuscular flaps was created at the anterior wall of the remnant stomach. After re-insufflation of the abdomen, the remnant stomach was pushed into the mediastinum through the esophageal hiatus to complete the abdominal part of the operation. Then, the patient was converted from the supine position to the prone position to start the thoracic part. Under the thoracoscopic approach, the open-door anastomosis was performed. The superior end of mucosal window was fixed to the esophagus at 4cm proximal to the cut end. The distal end of the mucosal window was opened. The mucosa on the remnant stomach and the posterior wall of the esophagus were sutured. The anterior wall of the esophagus was sutured to the remnant stomach layer by layer. Finally, distal ends of both sides of the seromuscular flaps were fixed at a position 1cm below the distal end of the mucosal window to prevent gastroesophageal reflux. Both sides of the flaps were closed to complete the anastomosis.