OGC SO17 - Right lateral approach to left gastric pedicle and Usage of articulated Signia Tri-stapler in Laparoscopic abdominal phase of a 2-stage Oesophagectomy

Abstract Background Advancements in oesophagectomy surgery over the past decade has seen an increase in minimally invasive oesophagectomies (MIE) being performed. Studies showed MIE had considerable advantages over open oesophagectomy by reducing intraoperative blood loss and post-operative complications while maintaining similar oncological outcomes1. In the abdominal phase of the Ivor-Lewis 2-stage oesophagectomy, a posterior approach is commonly used to dissect posterior gastric and left gastric vessels2. Method A 40-year-old patient with early malignant lesion underwent laparoscopic 2-stage oesophagectomy. In this video, we demonstrate using a right lateral approach to access and divide the left gastric vein and artery. Lymphadenectomy of stations 7 and 8a was also completed. A pyloroplasty is performed along with fashioning a gastric conduit using an articulated Signia tri-stapler, a smart stapler that adapts in real-time to tissue variability. Results The right lateral approach is superior to the more commonly used posterior lesser sac approach as it provides visuals of key vessel structures and spleen thereby reducing the risk of injury and bleeding. In the second stage, the Signia tri-stapler allows precise manoeuvres with fully powered articulation, rotation, and clamping, resulting in consistent staple lines and stronger staple lines. Conclusion Oesophagectomies remain a highly technical surgery with varied practices across centres and we would like to propose using a right lateral approach and articulated tri-stapler as a better technique that would reduce risk of bleeding and leaks.