The use of reduced port laparoscopic surgery (RPS) has become increasingly popular. The concept of RPS includes all procedures derived from various efforts minimizing the invasiveness of surgery, with single-incision laparoscopic surgery (SILS) being the ultimate reduced port technique. Reduced-port laparoscopic gastrectomy (RPLG) for gastric cancer has not yet been fully established and still has issues such as feasibility, oncological validity, training, and education. The short-term results of reported studies are acceptable. However, long-term results that verify positive results or radical cure even in cases of cancer have not yet been published. Patients for whom RPLG is indicated should be selected carefully. Prospective multicenter studies should be conducted to establish RPS as a truly evidence-based practice that addresses not only cosmesis but also the appropriate balance between minimal invasiveness and radical cure.

No abstract

Introduction We investigated the effectiveness of a self-gripping mesh, which has microgrips attached to fibrous tissue, in laparoscopic transabdominal preperitoneal (TAPP) obturator hernia (OH) repair to minimize the risk of postoperative pain and obturator nerve injury. Presentation of case The patient was an 80-year-old woman who was transferred to our emergency department with abdominal pain in the right lower quadrant and low back pain that began half a day prior to presentation. Computed tomography (CT) detected right OH. Based on the results of the laboratory examination and dynamic CT, intestinal viability was maintained. Ultrasonography-assisted manual reduction of the incarcerated intestine was performed, followed by admission to our department to check for delayed perforation of the intestine. Laparoscopic TAPP OH repair was performed on day seven as an elective surgery. A self-gripping mesh was placed over the OH defect and the femoral ring without tacking. The patient was discharged on postoperative day four, without any complications. Discussion Tacking of the mesh at the lateral and dorsal sides of the obturator canal is dangerous due to the presence of the obturator nerve and vessels. Self-gripping mesh use in laparoscopic TAPP OH repair is a rational decision in terms of avoiding tacking or suturing around the obturator canal while maintaining stable fixation of the mesh to prevent recurrence. Conclusion Laparoscopic TAPP OH repair with self-gripping mesh is a rational treatment option that reduces the risk of obturator nerve injury while maintaining the secure fixation of a mesh to prevent recurrence.

Introduction Single‐incision laparoscopic gastrectomy can be difficult because of complex instrumentation and a limited working angle. We standardized a needle device‐assisted single‐incision laparoscopic gastrectomy (NA‐SILG) procedure for early gastric cancer in 2013. Herein, we present our technique and evaluate it in comparison to the conventional laparoscopic gastrectomy CLG) technique. Methods We retrospectively reviewed medical records of 149 patients who underwent a NA‐SILG or distal (CLG) for early gastric cancer between January 2013 and August 2016. We performed 1:1 propensity score matching between the two groups. Results Eighteen patients who underwent a NA‐SILG and 131 who underwent a CLG were included. Almost all patients were in clinical stage IA. Operative times were 216 ± 29.7 minutes and 220 ± 51.7 minutes for the NA‐SILG and CLG groups, respectively; the median intraoperative bleeding amounts were 5 mL and 10 mL for the NA‐SILG and CLG groups, respectively. The median number of retrieved lymph nodes was 41.5 and 57 for the NA‐SILG and CLG groups, respectively. The number of patients needing analgesics was significantly lower in the NA‐SILG group (P = .003) than in the CLG group. Neither group had postoperative complications more severe than Clavien‐Dindo classification III. Conclusion Needle device‐assisted SILG is safe and feasible for early gastric cancer treatment in slim figure patients. It has short and long‐term outcomes comparable to the CLG but is less invasive and results in less postoperative pain.

Situs inversus totalis is a rare congenital anomaly. Most surgeons have seldom performed laparoscopy‐assisted distal gastrectomy for situs inversus totalis. Inadequate knowledge regarding the anatomy of situs inversus totalis can result in increased intraoperative bleeding and prolonged operative time. A 74‐year‐old man was diagnosed with early gastric cancer with situs inversus totalis. We performed laparoscopy‐assisted distal gastrectomy with D1+ lymphadenectomy and Billroth‐I reconstruction by reversing the standard laparoscopy‐assisted distal gastrectomy setup. Mirror images of the operative video of the standardized laparoscopy‐assisted distal gastrectomy were created using video editing software. Lymphadenectomy was performed by indocyanine green fluorescence imaging of the lymphatic flow with operative time of 220 minutes and 100 mL intraoperative bleeding. The patient was discharged on postoperative day 10, without postoperative complications. Laparoscopy‐assisted distal gastrectomy with indocyanine green navigation is safe and effective in patients with situs inversus totalis and is comparable with standard laparoscopy‐assisted distal gastrectomy.