title: Three Trocars Laparoscopic Total Gastrectomy + D2 Lymphadenectomy with Intracorporeal Manual Esojejunostomy.
abstract: BACKGROUND
  Minimally invasive surgery (MIS) is proved to be feasible and safe oncologically. In the past decade, a new philosophy of MIS, reducing abdominal trauma and improving the cosmetic results, has been popularized.1-3The authors report a three trocars laparoscopic total gastrectomy + D2 lymphadenectomy for lesser curvature gastric adenocarcinoma.
  A 52-year-old woman presenting a nondifferentiated gastric adenocarcinoma at the incisura angularis was admitted at consultation. Preoperative workup showed a T3N+M0 tumor. After neoadjuvant chemotherapy, laparoscopy was scheduled. Three trocars (5, 12, 5 mm) were placed in the abdomen. The operative field's exposure was improved by temporary percutaneous sutures. En bloc total gastrectomy and omentectomy was performed with a D2 lymphadenectomy, including the nodes of the stations 1, 2, 3, 4, 5, 6, 7, 8a, 8p, 9, 10, 11p, 11d, and 12a. Completely manual end-to-side esophago-jejunal anastomosis (Fig. 1a, b) and linear mechanical side-to-side jejuno-jejunal anastomosis were realized with the closure of both mesenteric and mesocolic defects. The specimen was retrieved through a suprapubic access.
  
  
  RESULTS
  Operative time was 4 hours and 45 minutes (anastomosis: 30), and perioperative bleeding was 100 cc. Pathologic report confirmed nondifferentiated adenocarcinoma, mucinous, G3, infiltrating entirely the gastric wall, with 63 (4 positive) nodes removed; 7 edition UICC stage: pT4aN2aM0; keratine AE1/AE3 negative, HER2/neu, and HER2/CEP17 nonamplified. During postoperative follow-up, no recurrence was detected after 2 years.
  
  
  CONCLUSIONS
  Reduced port laparoscopic surgery provides the same quality of oncologic surgery as conventional multitrocar laparoscopy with added superior cosmesis and reduced abdominal trauma.
authors.affiliation: Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium. giovanni@dapri.net.|Laboratory of Anatomy, Faculty of Medicine and Pharmacy, University of Mons, Mons, Belgium. giovanni@dapri.net.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Dapri
authors.affiliation: Department of Pathology, Saint-Pierre University Hospital and Jules Bordet Institut, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Maria Galdon
authors.initials: MG
authors.lastname: Gomez
authors.affiliation: Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Guy-Bernard
authors.initials: GB
authors.lastname: Cadière
authors.affiliation: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Han-Kwang
authors.initials: HK
authors.lastname: Yang
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D004940:Esophageal Stenosis; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007582:Jejunostomy; D010535:Laparoscopy; D007902:Length of Stay; D008197:Lymph Node Excision; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D061646:Operative Time; D011379:Prognosis; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013525:Surgical Instruments