There are various methods described in literature. Would like to ear hits, pros and cons from Colleagues.
We crossstapled the oesophagus with an EndoGIA and use the OrVil device to place the avil of 25mm CEA gun into the oesophageal lumen. A small hole is make in the middle of the oesophageal stump staple line and the OrVil NGT retrieved and the sutures cut and the anvil placed. A minithoracotomy is used to remove the specimen and form the gastric conduit and the CEA gun placed via a gastrostomy and other part of the staple gun advanced through the gastric conduit. Its then docked under thoracoscopic guidance and the gun fired. The gastrotomy hole for the staple gun entry is then closed with an endoGIA. I hope this makes sense?
I do use this technique as well and have done 26 cases with 2 anastomotic leak treated conservatively and no death. The main difficulty I experience is in the process of docking. For me getting the alignment right so that anvil clicks in has not been easy especially in patients with thick chest wall. Have you experience similar difficulties?
I think the best way to do it is using a normal "open" CEA as described by Luketich. By using a mini-thoracotomy (4-5 cm) you can introduce the anvil in the thorax cavity and than position it in the esophageal stump using EndoStitch.
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