title: Intracorporeal reconstruction after laparoscopic pylorus-preserving gastrectomy for middle-third early gastric cancer: a hybrid technique using linear stapler and manual suturing.
abstract: OBJECTIVE
  Laparoscopy-assisted pylorus-preserving gastrectomy has been increasingly reported as a treatment for early gastric cancer located in the middle third of the stomach because of its low invasiveness and preservation of pyloric function. Advantages of a totally laparoscopic approach to distal gastrectomy, including small wound size, minimal invasiveness, and safe anastomosis, have been recently reported. Here, we introduce a new procedure for intracorporeal gastro-gastrostomy combined with totally laparoscopic pylorus-preserving gastrectomy (TLPPG).
  
  
  METHODS
  The stomach is transected after sufficient lymphadenectomy with preservation of infrapyloric vessels and vagal nerves. The proximal stomach is first transected near the Demel line, and the distal side is transected 4 to 5 cm from the pyloric ring. To create end-to-end gastro-gastrostomy, the posterior wall of the anastomosis is stapled with a linear stapler and the anterior wall is made by manual suturing intracorporeally. We retrospectively assessed the postoperative surgical outcomes via medical records. The primary endpoint in the present study is safety.
  
  
  RESULTS
  Sixteen patients underwent TLPPG with intracorporeal reconstruction. All procedures were successfully performed without any intraoperative complications. The mean operative time was 275 min, with mean blood loss of 21 g. With the exception of one patient who had gastric stasis, 15 patients were discharged uneventfully between postoperative days 8 and 11.
  
  
  CONCLUSIONS
  Our novel hybrid technique for totally intracorporeal end-to-end anastomosis was performed safely without mini-laparotomy. This technique requires prospective validation.
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimal, Morioka, 020-8505, Japan. keikoeda@iwate-med.ac.jp.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Koeda
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimal, Morioka, 020-8505, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Chiba
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimal, Morioka, 020-8505, Japan.
authors.forename: Hironobu
authors.initials: H
authors.lastname: Noda
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimal, Morioka, 020-8505, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Nishinari
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimal, Morioka, 020-8505, Japan.
authors.forename: Takenori
authors.initials: T
authors.lastname: Segawa
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimal, Morioka, 020-8505, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Akiyama
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimal, Morioka, 020-8505, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Iwaya
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimal, Morioka, 020-8505, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nishizuka
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimal, Morioka, 020-8505, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nitta
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimal, Morioka, 020-8505, Japan.
authors.forename: Koki
authors.initials: K
authors.lastname: Otsuka
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimal, Morioka, 020-8505, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Sasaki
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011708:Pylorus; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D013528:Surgical Staplers; D013536:Suture Techniques; D016896:Treatment Outcome
keywords: Gastric cancer; Intracorporeal anastomosis; Laparoscopic gastrectomy; Pylorus-preserving gastrectomy