全腹腔镜全胃切除食管空肠吻合，因操作位置深、技术难度大、手术风险高且对团队配合要求严苛，一直是临床讨论的热点。其吻合方式主要包括直线型切割闭合器吻合、圆形吻合器吻合及手工吻合。手工吻合对术者腹腔镜下缝合技术水平要求高，可重复性较差，临床应用有限。直线型切割闭合器吻合是目前临床最常用的方式，操作相对简便，但需切除4.5~6.0 cm的正常食管，若肿瘤位置较高或边界不清，经腹操作往往难以保证足够的上切缘。圆形吻合器吻合则可保留较长的食管下端及切除位置较高的肿瘤，是更符合解剖与功能需求的重建方式。然而，反穿刺法、OrVil™法等圆形吻合器吻合方法，常存在操作烦琐、依赖特殊器械或并发症风险较高等问题。近年来，手工荷包缝合、腹腔镜下荷包钳联合多功能密封圈等技术和器械的应用，为全腹腔镜下圆形吻合器食管空肠吻合提供了新的解决思路。但腹腔镜下圆形吻合器食管空肠吻合的每一个环节，从荷包制作、钉砧头放置到系膜裁剪、吻合器置入与吻合，均可能遇到一系列特殊情况，任一环节的操作失误均可能导致手术失败。因此，充分掌握术中特殊情况的应对策略，对全腹腔镜下圆形吻合器食管空肠吻合的安全开展与推广具有重要意义。

Esophagojejunal anastomosis after totally laparoscopic total gastrectomy remains clinically challenging due to deep location, technical difficulty, and demanding teamwork. Current techniques include linear stapling, circular stapling, and hand-sewn anastomosis. Hand-sewn anastomosis requires advanced laparoscopic skill, offers poor reproducibility, and is thus limited in use. Linear stapling, while relatively simple, necessitates resection of 4.5-6.0 cm of normal esophagus and may compromise the proximal margin in high or ill-defined tumors. Circular stapling preserves more distal esophagus and allows higher resection, better aligning with anatomical and functional goals. However, conventional circular stapling methods, such as the reverse puncture and OrVil™ techniques, can be cumbersome, dependent on specialized instruments, or carry higher complication risks. Recently, hand-sewn purse-string sutures and novel laparoscopic purse-string suture clamps and multi-functional seal caps have provided new solutions for totally laparoscopic circular anastomosis. Each step of this procedure, from purse-string creation and anvil placement to mesenteric division, stapler insertion, and anastomosis, may present specific challenges, and technical errors at any step may lead to surgical failure. Thus, proficiency in managing these intraoperative situations is crucial for safe and broader adoption of the technique.