title: Three United Laparoscopic Surgery for the Treatment of Gastric Cardia Cancer-A Comparative Study with Laparotomy and Laparoscopy-Assisted Surgery.
abstract: OBJECTIVE
  Gastric cancer is a leading cause of cancer-related mortality worldwide. We have invented a novel hand-assist device that allows the placement of surgical instruments and the maneuvering of the surgeon's hand, and we have established a new hand-assisted laparoscopic technique called Three United Laparoscopic Surgery (TULS) for laparoscopic dissection of advanced gastric cancer. The present study aimed at exploring the usefulness of TULS in the treatment of advanced gastric cardia cancer.
  
  
  METHODS
  A retrospective study on 100 patients with advanced gastric cardia cancer admitted from January 2014 to June 2015 was done. There were 38 cases of TULS, 30 cases of laparotomy, and 32 cases of laparoscopy-assisted surgery. Statistical comparisons between three treatment groups in operative time, incision length, amount of bleeding, number of lymph nodes dissected, time to flatus after surgery, rate of postoperative complications, hospital stay, and expense were done.
  
  
  RESULTS
  For lymph node dissection, there were no significant differences between TULS, laparotomy, and laparoscopy-assisted surgery. However, compared with conventional laparotomy, TULS and laparoscopy-assisted surgery were found to be able to minimize incision length, reduce blood loss during surgery, lower postoperative complication rate, and shorten time to flatus and hospital stay. The differences were statistically significant (P < .05). The operative time of TULS was significantly shorter than that of the laparoscopy-assisted surgery (P < .05), and it was comparable to that of laparotomy.
  
  
  CONCLUSIONS
  TULS is as efficient as laparotomy in lymph node dissection, and it shows the advantages of minimally invasive surgery. It can be considered a novel and promising surgical intervention for treatment of advanced gastric cancer.
authors.affiliation: Department of Neurosurgery, The Second Hospital of Hebei Medical University , Shijiazhuang, China .
authors.forename: Zhanxue
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, The Second Hospital of Hebei Medical University , Shijiazhuang, China .
authors.forename: Shuyuan
authors.initials: S
authors.lastname: Sun
authors.affiliation: Department of Neurosurgery, The Second Hospital of Hebei Medical University , Shijiazhuang, China .
authors.forename: Jinchun
authors.initials: J
authors.lastname: Qi
authors.affiliation: Department of Neurosurgery, The Second Hospital of Hebei Medical University , Shijiazhuang, China .
authors.forename: Shaofan
authors.initials: S
authors.lastname: Qiu
authors.affiliation: Department of Neurosurgery, The Second Hospital of Hebei Medical University , Shijiazhuang, China .
authors.forename: Haijun
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, The Second Hospital of Hebei Medical University , Shijiazhuang, China .
authors.forename: Lina
authors.initials: L
authors.lastname: Ru
authors.affiliation: Department of Neurosurgery, The Second Hospital of Hebei Medical University , Shijiazhuang, China .
authors.forename: Lin
authors.initials: L
authors.lastname: Lin
authors.affiliation: Department of Neurosurgery, The Second Hospital of Hebei Medical University , Shijiazhuang, China .
authors.forename: Zhong
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, The Second Hospital of Hebei Medical University , Shijiazhuang, China .
authors.forename: Zongmao
authors.initials: Z
authors.lastname: Zhao
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D002299:Cardia / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D007902:Length of Stay; D008197:Lymph Node Excision / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D020127:Recovery of Function; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: TULS; advanced gastric cancer; laparoscopy; laparotomy