Learning curve for laparoscopy‐assisted distal gastrectomy

Yasuda, Kazuhiro; Shiraishi, Norio; Ito, Masafumi; Fujii, Kyuzo; Sonoda, Kazuya; Kitano, Seigo

doi:10.1046/j.1443-1661.2003.00262.x

Cited by 10 publications

(6 citation statements)

References 15 publications

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“…The average operating time for laparoscopic gastrectomy reported by other authors ranges between 209 and 280 min [1,3,5,11,12,26,37], and in this study it was 240 min, not significantly different from the mean operating time (220 min) needed in open surgery (Table 3). Mean blood loss reported in the literature ranges between 60 and 300 ml [1,3,5,8,26,37], and it was 150 ml in our study, significantly less than the mean blood loss (394 ml) in open surgery (Table 3). Many reports show that LOS after laparoscopic gastrectomy (6-17 days) is shorter than after open gastrectomy (9-25 days) [3, 8, 13, 16-19, 23, 24, 26, 27, 30, 31, 33, 34, 36, 37].…”

Section: Discussioncontrasting

confidence: 52%

Total and subtotal laparoscopic gastrectomy for adenocarcinoma

et al. 2006

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Section: Discussioncontrasting

confidence: 52%

Total and subtotal laparoscopic gastrectomy for adenocarcinoma

et al. 2006

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“…Although laparoscopic surgery is carried out with a clear amplified view of the operative field on the laparoscopy monitor, there is neither touch sensation nor an actual 3-D view of the internal structures. Therefore, the learning curve in the performance of LADG [49] and other laparoscopic surgeries should be considered to ensure that these procedures are performed safely.…”

Section: Short-term Outcome Of Ladgmentioning

confidence: 99%

Laparoscopic gastrectomy with lymph node dissection for gastric cancer

2006

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surgery, including less invasiveness, less pain, earlier recovery, and better cosmesis [2]. Kitano et al. [3] first applied and described laparoscopy-assisted distal gastrectomy (LADG) as treatment for early gastric cancer (EGC) in 1994.With the development of various diagnostic modalities and the spread of mass screening, EGC now accounts for more than 50% of the total incidence of gastric cancer in Japan. The low frequency of lymph node metastasis in patients with EGC is well known; it reportedly occurs in 2%-5% of those with mucosal cancer and 11%-20% of those with submucosal cancer [4]. To allow for the treatment of EGC in patients without a risk of lymph node metastasis, laparoscopic wedge resection (LWR) with a lesion-lifting method was developed by Ohgami et al. [5] in 1992, and intragastric mucosal resection (IGMR) was developed by Ohashi [6] in the early 1990s. With the recent development of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) [7], the use of LWR and IGMR seems to be decreasing, whereas the use of LADG with lymph node dissection has increased in patients with EGC with a risk of lymph node metastasis.The past 15 years have seen remarkable advances in laparoscopic surgical techniques and instruments, such as laparoscopic coagulating shears [8]. Extended lymph node dissection (D2) and total gastrectomy can now be performed laparoscopically [9,10]. However, LADG remains controversial as a standard surgery for gastric cancer because there are few studies evaluating the technical difficulty, advantages, and oncological feasibility of LADG.Here, we review reports, in the English-language literature, of LADG with lymph node dissection as treatment for cancer, to clarify the current status of this technique and related problems. AbstractSince 1991, laparoscopic surgery has been adopted for the treatment of gastric cancer, and it has been performed worldwide, especially in Japan and Korea. We reviewed the English-language literature to clarify the current status of and problems associated with laparoscopic gastrectomy with lymph node dissection as treatment for gastric cancer. In Japan, early-stage gastric cancer (T1/T2, N0) is considered the only indication for laparoscopic gastrectomy. As yet, there is little high-level evidence based on long-term outcome supporting laparoscopic gastrectomy for cancer, but reports have provided level 3 evidence that the procedure is technically safe, and that it yields better short-term outcomes than open surgery; that is, recovery is faster, hospital stay is shorter, there is less pain, and cosmesis is better. However, investigation into the oncological outcome of laparoscopic gastrectomy as treatment for cancer is lacking. To establish laparoscopic surgery as a standard treatment for gastric cancer, multicenter randomized controlled trials to compare the short-and longterm outcomes of laparoscopic surgery versus open surgery are necessary.

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“…Furthermore, cosmetically, a small 3 cm incision in the umbilicus is sufficient for extracting the stomach. We have treated 18 cases at our hospital, and although time was required to perform handsewn gastroduodenal anastomosis in the early cases, it is believed that the surgery time can be reduced if the procedures for anastomosis are standardized [16][17][18]. We plan to study and report further cases in the future.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic distal gastrectomy with intracorporeal handsewn Billroth-I anastomosis (ICHSA)

et al. 2012

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Background The number of cases of laparoscopic surgery has been increasing. Lymph node dissection has been standardized, and the enlarged view provided by laparoscopes allows for the procedure to be performed successfully entirely within the abdominal cavity, but many cases of reconstruction using the Billroth-I method are performed under direct vision through a small incision. In this study, by placing an anchor thread on a suture line on the lesser curvature of the stomach, we simplified the procedure for handsewn anastomosis and safely performed gastroduodenal anastomosis at low cost to obtain good results. Methods From January 2009 to December 2010, we performed handsewn gastroduodenal anastomosis in 18 cases. After performing lymph node dissection, the duodenum and the stomach were separated using an automatic stapling device. Anchor sutures were placed on the suture line of the lesser curvature of the stomach. First, the seromuscular layer of the stomach and the seromuscular layer of the duodenum were sutured by performing interrupted suturing using an extracorporeal knot-tying method. With the stomach and the duodenum in a fixed state, the anastomosis area was opened. The thread of the anchor suture was pulled toward the abdominal wall, and then all layers of the stomach and the duodenum at the posterior wall were continuously sutured. Similarly, for the anterior wall, all layers were continuously sutured from the lesser curvature toward the greater curvature. Results We performed this anastomotic procedure in 18 patients with early gastric carcinoma. The mean time required for the anastomosis was 64.6 ± 17.1 min, and the estimated blood loss was 53.1 ± 91 g. All operations were curative, and the mean number of retrieved lymph node was 27.1 ± 10.8. A nasogastric tube was removed on the first or second day. An upper gastrointestinal series performed on postoperative days 5-6 showed no anastomotic leakage and normal transit. Oral intake was started on days 6-7. Postoperative complications included one case of a ruptured suture, but this was resolved through a conservative approach. There was no mortality. Postoperative endoscopy revealed that the anastomosis area was extremely soft, and no abnormalities were observed. Moreover, the only costs related to the anastomosis were for the thread and needles, and although more time was required compared with mechanical anastomosis, the cost was extremely low. Conclusions We performed gastroduodenal anastomosis under a total laparoscopic approach by handsewn. This method is economical, because it does not require the use of machinery for anastomosis, and the duodenal stump is short. We believe that this method, which can be performed in a similar manner even for obese patients, can be used as a standard method of anastomosis.

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Learning curve for laparoscopy‐assisted distal gastrectomy

Cited by 10 publications

References 15 publications

Total and subtotal laparoscopic gastrectomy for adenocarcinoma

Total and subtotal laparoscopic gastrectomy for adenocarcinoma

Laparoscopic gastrectomy with lymph node dissection for gastric cancer

Laparoscopic distal gastrectomy with intracorporeal handsewn Billroth-I anastomosis (ICHSA)

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