全腹腔镜全胃切除＋D2淋巴结清扫＋Orvil辅助食管空肠Roux－en－Y吻合术

食管空肠吻合采用OrVil腔内行食管空肠Roux－en－Y吻合，巡回护士将OrVil装置经口放入，引导胃管缓慢送到食道下端并到达食道切缘，主刀用超声刀锐性切开食道切缘正中暴露OrVil的引导胃管，用肠钳将OrVil引导胃管从食道残端的小孔内拉出，直到食道切缘的小孔卡住钉砧头，然后剪断OrVil与引导胃管之间的连接线，确定屈氏韧带，远端25 cm处直线切割闭合器离断空肠，残端包埋，结肠前上提远端。取上腹正中切口，长约4 cm，放置切口保护器，外套装7号手套，于手套拇指剪切口进管状吻合器，重新建立气腹行腹腔镜下食管空场吻合。

Total laparoscopic total gastrectomy+ D2 lymph node dissection+ Orvil-assisted esophagojejunal Roux-en-Y anastomosis

Roux-en-Y esophagojejunostomy were performed by using OrVilTM. Firstly, itinerant nurse put the OrVil device through patient’smouth, which was guided by gastric tube and was slowly delivered to the lower end of esophagus then to the resection margin. The surgeon made a small hole on esophagus resection marginand exposed OrVil by usinggastric tube. Briefly, gastric tube was pulled out from the small hole on esophageal stump by intestinal forceps, then cut off the connection between OrVil and the gastric tube. The jejunum was cut off at 25 cm away from Treitz ligament by using a Endo-GIA stapler, and the remnant was embedded. Anterior colon esophagojejunal anastomosis were performed as following: a 4 cm median incision was made at upper abdomen, and incision protector was placed and stapler was used through a surgical glove with reconstructed pneumoperitoneum.