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◆要旨:腹腔鏡下胃全摘術や噴門側胃切除術における食道空腸吻合は,開腹術とは異なりリニアステイプラーを用いて行われることが多い.筆者らはサーキュラーステイプラー(以下,CS)を用いた腹腔鏡下食道空腸吻合を行うためにshort purse string instrument(以下,PSI)を考案した.この鉗子のアゴ長は35mmと短いため,短い直針が使用できることと創外から鉗子を把持できることで安全かつ容易に巾着縫合が行えるようになった.小開腹創は4cmあれば十分であり,ここよりCSを挿入し,良好な視野でストレスなく食道空腸吻合を行っている.
Esophagojejunostomy in laparoscopic total and proximal gastrectomy is often performed using a linear stapler although a circular stapler is used in open surgery.
We devised a short purse string instrument(PSI)in order to perform laparoscopic esophagojejunostomy using a circular stapler. Purse string suture is performed safely and easily because a short straight needle is used and the short PSI is held from the outside of the body. Laparotomy of 4 cm length is enough for the operation.
Circular stapler is inserted through this wound, and esophagojejunostomy is performed laparoscopically with good view and without stress.
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