title: Transumbilical single-incision laparoscopic distal gastrectomy for early gastric cancer.
abstract: BACKGROUND
  Laparoscopic gastrectomy is a widely accepted procedure for treating early gastric cancers. This procedure is less invasive than conventional open approaches, and the oncologic outcomes are comparable. Single-incision laparoscopic surgery, developed to reduce the invasiveness of traditional laparoscopy, is applied to various abdominal surgical procedures. However, its application to laparoscopic gastrectomy for the treatment of gastric cancer has not been reported, mainly because of difficulties achieving adequate lymphadenectomy and reconstruction. The authors report their initial clinical experience with single-incision laparoscopic gastrectomy for early gastric cancer.
  
  
  METHODS
  A single vertical 2.5-cm intraumbilical incision was made, and three laparoscopic trocars were placed within the umbilicus. A 2-mm mini-loop retractor was inserted in the left upper and middle abdomen, and a roll of gauze was attached to its tip. This instrument is an atraumatic and useful tool for retracting various organs. Gastric mobilization and adequate dissection of lymph nodes were performed. The stomach and duodenum then were transected intracorporeally using linear staplers. Intracorporeal anastomosis was performed for reconstruction.
  
  
  RESULTS
  All seven single-incision laparoscopic distal gastrectomies with lymphadenectomy were performed without the use of additional trocars or conversion to laparotomy. The median time for gastric mobilization with lymphadenectomy was 155 min (range, 130-183 min). The median operative time was 344 min (range, 282-385 min), and the median estimated blood loss was 25 ml (range, 0-100 ml). A median total of 67 lymph nodes were retrieved. No serious perioperative complications occurred, and no mortalities were observed in this case series.
  
  
  CONCLUSIONS
  The authors' initial experience with single-incision laparoscopic distal gastrectomy showed that it is a feasible and safe procedure for early gastric cancer and gives a favorable cosmetic result. To the authors' knowledge, this is the first report describing successful single-incision laparoscopic gastrectomy for gastric cancer.
authors.affiliation: Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, 543-0035, Japan. ohmori@oph.gr.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Omori
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Oyama
authors.forename: Hiroki
authors.initials: H
authors.lastname: Akamatsu
authors.forename: Masayuki
authors.initials: M
authors.lastname: Tori
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Ueshima
authors.forename: Toshirou
authors.initials: T
authors.lastname: Nishida
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial; D013274:Stomach Neoplasms / Q000601:surgery*; D017792:Surgical Stapling; D016896:Treatment Outcome; D014472:Umbilicus