title: Gasless laparoscopy-assisted distal gastrectomy for early cancer via mini-laparotomy using an abdominal wall lift.
abstract: OBJECTIVE
  To investigate the technical ease and results of gasless laparoscopy-assisted distal gastrectomy with lymph node dissection via mini-laparotomy using abdominal wall lift for early gastric cancer.
  
  
  METHODS
  We submitted 20 patients to laparoscopy-assisted distal gastrectomy for early gastric cancer located in the middle or lower stomach. The initial 10 cases underwent perigastric lymph node dissection (D1), and the subsequent 10 cases received further dissection around the left gastric and common hepatic arteries (D1 + a). Mini-laparotomy was placed at the beginning of the procedure. We lifted up the laparotomy and the subcutaneous tissue around the umbilicus by retractors. We accomplished the dissection, resection and reconstruction mainly via the mini-laparotomy using a direct view and a laparoscopic image.
  
  
  RESULTS
  Two cases were converted to open. The operative time was significantly longer in D1 + a (225 +/- 49 min) than in D1 (172 +/- 38 min). Blood loss was significantly more in D1 + a (247 +/- 155 mL) than in D1 (109 +/- 60 mL). There was no difference between the two groups in terms of days to first flatus, first oral intake or discharge from the hospital. Postoperative complications included 2 wound infections each in D1 and D1 + a group, and 1 anastomotic stenosis in D1 + a group.
  
  
  CONCLUSIONS
  Gasless laparoscopy-assisted distal gastrectomy with D1 + a via mini-laparotomy using abdominal wall lift seems to be feasible and useful for early gastric cancer.
authors.affiliation: Department of Surgery, Jichi Medical School, Minami-Kawachi, Tochigi, 329-0498 Japan. mhyodo@jichi.ac.jp
authors.forename: Masanobu
authors.initials: M
authors.lastname: Hyodo
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Hosoya
authors.forename: Taku
authors.initials: T
authors.lastname: Yokoyama
authors.forename: Wataru
authors.initials: W
authors.lastname: Arai
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Yasuda
authors.forename: Hideo
authors.initials: H
authors.lastname: Nagai
authors.forename: Chuuji
authors.initials: C
authors.lastname: Sekiguchi
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000295:instrumentation*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011028:Pneumoperitoneum, Artificial; D013270:Stomach / Q000473:pathology; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013523:Surgical Equipment; D013525:Surgical Instruments; D016896:Treatment Outcome