Abstract: Objective To investigate the application of transorally inserted anvil system OrViLTM in total thoracoscopic and laparoscopic radical esophagectomy， and to evaluate its feasibility， safety and efficacy. Methods Five patients of lower and middle thoracic esophageal cancer and 1 of cardia cancer were enrolled to receive total thoracoscopic and laparoscopic radical esophagectomy. The esophagogastric anastomosis was completed by using transorally inserted anvil system OrViL （Covident， CT，USA） and 25mm circular stapler on upper thoracic cavity under the vision of thoracoscope.
Results The operation of the 6 patients was successful and uneventful.The average operative time was 260min（210-340min）and blood loss was 120ml（100-250ml）. The average time of thoracic drainage was 4 days （3.6 days） and discharge time was 14.2 days （11-26 days）. After the operation， pulmonary infections occurred in 3 patients， and 1 in unilateral recurrent laryngeal nerve injury. No complications like chylothorax， anastomotic leakage or stenosis and other severe complications occurred. With a 6 to 24 months follow-up， no recurrence， distant metastasis or severe reflux observed. Conclusion The technique of total thoracoscopic and laparoscopic Ivor Lewis esophagectomy with transorally placed anvil system OrViL for the esophagogastric anastomosis in thoracic cavity is feasibility and safety， showing a good shortterm clinical outcome.