New purse-string suture clamp and multi-functional seal cap: a simple intracorporeal circular-stapled oesophagojejunostomy after laparoscopic total gastrectomy.

Background: Laparoscopic total gastrectomy (LTG) is still limited because intracorporeal oesophagojejunostomy is technically demanding and difficult in laparoscopic gastrectomy. Circular-stapled anastomosis is considered the "gold standard" method for oesophagojejunostomy in open total gastrectomy. A purse-string suture instrument is used to create a purse-string suture along the distal oesophagus as a standard technique for classic circular-stapled oesophagojejunostomy in the open total gastrectomy. However, a simple and optimal laparoscopic purse-string suture device or instrument with an appropriate and optimal tube in the abdomen remains to be developed as a standard procedure for simple intracorporeal oesophagojejunostomy.

Study design: Between May 2023 and October 2023, a new laparoscopic purse-string suture clamp (Lap-PSC) and multi-functional seal cap (MSC) were applied to obtain a simple intracorporeal circular-stapled oesophagojejunostomy after laparoscopic total gastrectomy in 21 patients with gastric cancer in our hospital. The surgical details and postoperative outcomes were analyzed to evaluate this method.

Results: The mean operation time was 203.8 ± 39.1 min. The mean time for the purse-string suture was 6.6 ± 2.8 min. An average of 13 min was required for purse-string creation and anvil placement. Tumor-free margins were obtained in 21 patients, with a median proximal margin length of 2 cm (range, 1.5-5 cm). Four postoperative complications occurred in this study. There was no mortality. During the median follow-up periods of 11 months, no anastomosis-related complications were observed.

Conclusions: The standardized single-stapling end-to-side oesophagojejunostomy in open surgery can be easily and safely performed during LTG using both Lap-PSC and MSC. The procedure using Lap-PSC with MSC may be considered as a better procedure to option in LTG.