title: Video: laparoscopy distinctive technique for suprapancreatic lymph node dissection: medial approach for laparoscopic gastric cancer surgery.
abstract: BACKGROUND
  Suprapancreatic lymph node (LN) dissection is critical for gastric cancer surgery. Until currently, a number of laparoscopic gastrectomy procedures have been performed in the same manner as open surgery procedures [3, 4, 6]. Using the characteristic of laparoscopic surgery, the authors developed a new technique of suprapancreatic LN dissection.
  
  
  METHODS
  After division of the duodenum, No. 8a LN is raised, and the surrounding tissue is dissected to identify the outmost layer of the nerves around the common hepatic artery. This layer can be dissected as the next step is headed for the root of the left gastric artery. Thin layers can be identified on the left and right sides of the artery. After this step, the LN dissection is performed toward both lateral sites, keeping the outmost layer of the nerves. At this stage, the surgeon should envision the "U" shape on the right side and the "V" shape on the left side for a superior performance. This technique was performed by the same surgeon for 20 consecutive patients with advanced gastric cancer.
  
  
  RESULTS
  All the patients successfully underwent laparoscopic distal gastrectomy with D2 LN dissection. The mean number of regional LNs retrieved was 45.1 ± 13.5. The mean number of only LNs around the celiac artery (No. 7, 8a, 9, 11p, and 12a) was 17.8 ± 5.5. This was not less than reported previously [1, 2, 5]. The mean blood loss was 91.1 ml, and the mean operative time was 296.0 min. At this writing, all the patients are disease free after a mean follow-up period of 15.4 months.
  
  
  CONCLUSIONS
  The nerves are thick and sturdy around the root of the left gastric artery. Additionally, the magnified and horizontal laparoscope view provides a straightforward approach and visibility to the layer. The authors believe that the "medial approach" is a straightforward method of suprapancreatic LN dissection in laparoscopic gastric cancer surgery.
authors.affiliation: Department of Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan. skanaya@fujita-hu.ac.jp
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Kanaya
authors.forename: Shusuke
authors.initials: S
authors.lastname: Haruta
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kawamura
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Yoshimura
authors.forename: Kazuki
authors.initials: K
authors.lastname: Inaba
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Hiramatsu
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ishida
authors.forename: Keizo
authors.initials: K
authors.lastname: Taniguchi
authors.forename: Jun
authors.initials: J
authors.lastname: Isogaki
authors.forename: Ichiro
authors.initials: I
authors.lastname: Uyama
mesh_terms: D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*