Esophagectomy and Reverse Gastric Tube: Gavriliu I
Step 1: Ligation and division of the short gastric vessels
The pertinent vascular anatomy is demonstrated. The gastroepiploic vessels are not always as beautifully continuous as they are shown, and, in fact, there usually is a gap high up on the fundus, bridged by reliable intramural vascular connections. While taking care to protect the left gastroepiploic arcade, the short gastric vessels are ligated and divided, either manually or with the LDS stapling instrument, close to their origin from the splenic vessels, following incision of and exposure through the gastrosplenic ligament. When activated, the LDS instrument places two crescent-shaped staples, ligating the tissue held within the jaw of the instrument, and evenly cuts between them.