Reverse layout of the remnant esophagus and stomach during right transthoracic valvuloplastic esophagogastrostomy in robotic esophagogastric junctional cancer surgery.

Valvuloplastic esophagogastrostomy by a double flap technique has promise for preventing reflux after proximal gastrectomy. However, a short esophageal remnant sometimes strongly complicates the transhiatal procedure for alimentary tract reconstruction. We therefore developed secure robotic techniques for right transthoracic esophagogastrostomy by a double flap technique. To accomplish valvuloplastic esophagogastrostomy by this double flap technique in the right thorax of patients in the prone position, the esophagus and stomach were partially fixed before rotating these two organs to expose the anterior gastric wall side for anastomosis because it was invisible in the right thorax. However, this rotation process was complicated. Doubting that the required anastomosis that was conventionally created in the layout of the ventral esophagus and dorsal stomach in valvuloplastic esophagogastrostomy by a double flap technique protected against reflux, we have considered that, if the anastomosis is created at the posterior gastric wall, it may not be necessary to rotate the remnant esophagus and stomach. We herein describe a modified robotic procedure for right transthoracic valvuloplastic esophagogastrostomy incorporating a double flap technique. In this procedure, the anastomosis is created at the posterior remnant gastric wall under a natural operative view without re-arranging the anastomotic organs. This modified technique simplifies right transthoracic valvuloplastic esophagogastrostomy by a double flap technique without adversely influencing anti-acid reflux mechanisms.