The initial experience of dual port laparoscopy-assisted total gastrectomy as a reduced port surgery for total gastrectomy

Abstract

Reduced port surgery (RPS), in which fewer ports are used than that in a conventional laparoscopic procedure, is becoming increasingly popular for various surgeries. However, the application of RPS to the field of gastrectomy is still underdeveloped. We started laparoscopy-assisted total gastrectomy through an umbilical port plus another 5 mm port (dual port laparoscopy-assisted total gastrectomy: DP-LATG) as an RPS for laparoscopyassisted total gastrectomy (LATG). A SILS TM port was inserted into an umbilical incision, while another 5 mm port was inserted at the right flank region. We performed DP-LATG on ten early gastric cancer cases consecutively from May 2011 onwards, with the surgeries all performed by a single surgeon. The results of DP-LATG were compared with the resuls of ten conventional LATGs (C-LATGs) that were performed between March 2010 and April 2011. There were no significant differences in the mean operation time (DP-LATG, 253.0 ± 26.8 min; C-LATG, 235.5 ± 20.6 min; p = 0.119), mean blood loss (33.4 ± 23.7, 39.8 ± 60.4 mL, p = 0.759), and number of lymph nodes dissected (31.6 ± 12.3, 40.9 ± 18.7, p = 0.205). There were no intraoperative complications, there was no need for additional ports, and there were no conversions to open surgery nor postoperative complications in the DP-LATG cases. We successfully and safely performed DP-LATG without incurring any notable differences from C-LATG in terms of operation time, blood loss, and number of lymph nodes dissected.

Application of reduced-port laparoscopic total gastrectomy in gastric cancer preserving the pancreas and spleen

“…When dissecting lymph nodes along the suprapancreatic arteries, we found that using the left hand was safe and smooth while retracting the pancreas to the dorsal side using the right hand. Successful results using single-port or reduced-port laparoscopic surgery for distal gastrectomies in patients with early gastric cancer have been reported previously [17][18][19]. An experienced and skillful surgeon can perform such complex laparoscopic gastrectomies after gaining sufficient experience of conventional laparoscopic gastrectomies.…”

A systematic review of laparoscopic total gastrectomy for gastric cancer

“…Although current surgical procedures for LTG have not yet been widely established and standardized, reports have appeared concerning the application of more advanced techniques, such as robotic total gastrectomy [64,65] and reduced-port LTG [66,67]. Robotic gastrectomy has been reported to provide manipulations as reliable as those provided by LTG.…”

Laparoscopic Total Gastrectomy for Gastric Cancer

“…Kunisaki et al 43 and Kawamura et al 44 compared conventional LTG with dual-port LTG (Table 5). Kunisaki et al reported that the operative time was significantly longer with dual-port LTG (319.0 min) than with conventional LTG (259.0 min).…”