title: Single port Billroth I gastrectomy.
abstract: BACKGROUND
  Experience has allowed increasingly complex procedures to be undertaken by single port surgery. We describe a technique for single port Billroth I gastrectomy with a hand-sewn intracorporeal anastomosis in the resection of a benign tumour diagnosed incidentally on a background of cholelithiasis.
  
  
  METHODS
  Single port Billroth I gastrectomy and cholecystectomy was performed using a transumbilical quadport. Flexible tipped camera and straight conventional instruments were used throughout the procedure. The stomach was mobilised including a limited lymph node dissection and resection margins in the proximal antrum and duodenum were divided with a flexible tipped laparoscopic stapler. The lesser curve was reconstructed and an intracorporal hand sewn two layer end-to-end anastomosis was performed using unidirectional barbed sutures. Intraoperative endoscopy confirmed the anastomosis to be patent without leak.
  
  
  RESULTS
  Enteral feed was started on the day of surgery, increasing to a full diet by day 6. Analgesic requirements were a patient-controlled analgesia morphine pump for 4 postoperative days and paracetamol for 6 days. There were no postoperative complications and the patient was discharged on the eighth day. Histology confirmed gastric submucosal lipoma.
  
  
  CONCLUSIONS
  As technology improves more complex procedures are possible by single port laparoscopic surgery. In this case, flexible tipped cameras and unidirectional barbed sutures have facilitated an intracorporal hand-sewn two layer end-to-end anastomosis. Experience will allow such techniques to become mainstream.
authors.affiliation: Regional Oesophago-gastric Unit, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU2 7XX, United Kingdom.
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Huddy
authors.forename: Karim
authors.initials: K
authors.lastname: Jamal
authors.forename: Yuen
authors.initials: Y
authors.lastname: Soon
keywords: Gastrectomy; single port access surgery; surgery