Hand-assisted laparoscopic total gastrectomy for early gastric cancer.
Laparoscopy-assisted distal gastrectomy has been applied to the treatment of early gastric cancer in Japan. However, there have been few reports on the laparoscopy-assisted total gastrectomy mainly because of the difficulty of the procedure. Here, we report a series of cases where hand-assisted laparoscopic total gastrectomies were performed successfully. The mobilization of the greater curvature was performed laparoscopically. About 7-cm mini-laparotomy was made at the epigastrium and duodenal transection was performed with linear stapler. After dissection of suprapyloric and anterosuperior lymph nodes was performed through the mini-laparotomy, dissection of lymph nodes along the celiac artery, and the left gastric artery was performed by hand-assisted laparoscopic surgery. Roux-en-Y reconstruction was performed through the mini-laparotomy. We successfully performed this procedure in 5 patients. The mean operating time and blood loss were 275 minutes and 177.5 mL, respectively. Hand-assisted laparoscopic total gastrectomy is suitable and feasible for early gastric cancer.
Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan. usui540@med.showa-u.ac.jp
Shinsuke
S
Usui
Haruhiro
H
Inoue
Tatsuya
T
Yoshida
Norio
N
Fukami
Shin-ei
SE
Kudo
Takehisa
T
Iwai
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome