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Page 8 of 14 Parthasarathi et al. Mini-invasive Surg 2019;3:20 I http://dx.doi.org/10.20517/2574-1225.2019.10

Figure 10. Proximal esophagus full-thickness sutures preventing mucosal retraction

Figure 11. End to end esophagogastric anastomosis

in two layers interrupted sutures using 2-0 PDS (polydioxanone) (© Ethicon US, LLC). Side to side semi-
mechanical anastomosis: Using linear staplers, intrathoracic side to side esophagogastric anastomosis
done. The stapler entry wound to be closed with 2-0 PDS. End to side fully mechanical anastomosis: When
gastric conduit width is more, stapling technique is preferred, and narrower tube hand-sewn anastomosis
is done.

The linear stapling technique 12 mm trocar is placed in the 11/12th intercostal space for stapler insertion
[Figure 12]. The trocar is placed at the angle of the rib. Using monopolar cautery, enterotomy is made on
the staple line of the stomach, and similarly, entry is made at the stapled edge of the esophagus. When the
esophagus is divided without a staple, then one of the jaws may be placed directly into the lumen and side
to side anastomosis is done by linear anastomosis. The anterior anastomosis is done by intrathoracic hand-
sewn suturing technique or a stapler in triangulation manner.

Intra-corporeal anastomosis by hand suturing technique
Ends of the gastric conduit and the esophagus are trimmed, and end to end anastomosis is done. 3-0 PDS with
a small curved needle is used for suturing.