Reverse-Puncture Anastomotic Technique for Minimally Invasive Ivor-Lewis Esophagectomy.

We used a reverse-puncture anastomotic technique in a total minimally invasive Ivor-Lewis esophagectomy. In the operation, a needle with a wire passed through the puncture head of the anvil of a circular stapler was used to make a fixed knot. In the proximal esophagus, the tissue was hemitransected, and the anvil was then inserted into the esophagus. The needle was then pulled from the inner to the anterior wall of the esophagus. After the wire was tightened, the center rod of the anvil was removed. After closure of the esophageal stump, the intrathoracic esophagogastrostomy was completed.