Esophagojejunostomy after laparoscopic total gastrectomy by OrVilTM or hemi-double stapling technique

Figure 1 OrVil^TM procedure. A: The central rod of the anvil connected with a tube; B: The lower esophagus was dissociated, and the esophagus was closed and cut; C: The tube of the OrVil^TM system was transorally inserted into the esophagus, and the head of the tube was pulled out from the small hole at the end of the esophagus; D: The tube was pulled out until the anvil that connected with the end of the tube reached the esophageal stump; E: The connection line between the tube and anvil was cut down, and the tube was pulled out.

Figure 2 Hemi-double stapling technique procedure. A: The tail of the central rod of the anvil was sutured with sutures that contained a needle; B: The anvil with needle-containing sutures was inserted into the esophagus via the incision on the lower edge of the esophagus; C: The needle was inserted through the anterior wall of the esophagus, and the needle and sutures were pulled out from the anterior wall of the esophagus; D: The lower edge of the esophagus was closed off and cut down using a linear cutter; E: The sutures were further retracted until the central rod of the anvil was completely pulled out.

Figure 3 Patients’ flowchart. Flowchart of the subject inclusion and allocation into group I and group II for the different insertion techniques for esophagojejunostomy. HDST: Hemi-double stapling technique.

Figure 4 Comparison of the total cost of hospitalization and operation between the two groups. Dark grey represents the cost using the OrVil^TM system (Group I) and light grey represents the cost using the hemi-double stapling technique (HDST) method (Group II). The cost of operation using the OrVil^TM system was significantly greater than that of using the HDST method (P < 0.001, Group I vs Group II).