A Novel Technique of SureForm–Based Intrathoracic Esophago-Gastric Anastomosis in RAMIE

This video demonstrates a standardized, fully robotic approach to SureForm-based gastric conduit preparation and a novel SureForm stapler–based intrathoracic esophago-gastric anastomosis with pleural patch reinforcement during robotic-assisted minimally invasive esophagectomy.

The video begins with gastric conduit creation using the robotic SureForm stapler. Key steps highlighted include preservation of the right gastroepiploic arcade, uniform conduit width, precise stapler alignment, and avoidance of torsion to ensure optimal conduit perfusion. The advantages of robotic stapling, including controlled articulation, consistent staple formation, and surgeon autonomy, are emphasized.

Following thoracic mobilization of the esophagus, a totally robotic intrathoracic esophago-gastric anastomosis is performed using the SureForm stapler. Under three-dimensional magnified visualization, precise enterotomies are created on the esophageal stump and gastric conduit. The stapler is used to construct the anastomosis and close the common channel in a controlled, stepwise manner, ensuring accurate tissue apposition and a tension-free anastomosis without reliance on bedside stapling or hand suturing.

A novel aspect of this technique is pleural patch reinforcement, wherein mediastinal pleural flap is mobilized and used to buttress the anastomosis. This reinforcement aims to enhance anastomotic protection, potentially reducing the risk of leak and mediastinal contamination, while maintaining technical simplicity.

The video concludes by summarizing key technical pearls, including conduit orientation, stapler positioning, perfusion assessment, and reproducibility of the technique. This standardized SureForm-based approach demonstrates a safe, efficient, and fully robotic strategy for gastric conduit preparation and intrathoracic esophago-gastric anastomosis during robotic-assisted minimally invasive esophagectomy.

Видео A Novel Technique of SureForm–Based Intrathoracic Esophago-Gastric Anastomosis in RAMIE канала Dr Devendra Parikh