Three-Step Hand-Assisted Laparoscopic D2 Radical Gastrectomy for Chinese Obese Patients: A Highly Efficient and Feasible Surgical Approach

Abstract

Three-step hand-assisted laparoscopic D2 radical gastrectomy (HALG) is a modified surgical procedure that has achieved satisfactory results for obese patients in our surgical center. To fully elucidate the advantages of this procedure, in this study, comprehensive and in-depth comparative analyses were performed to assess clinical data from obese gastric cancer patients who underwent HALG, laparoscopic-assisted D2 radical gastrectomy (LAG), and open D2 radical gastrectomy (OG) in our surgical center during a specific time period. For the 3 groups, incision length was 1.25 cm longer for the HALG group than for the LAG group but was significantly shorter for the HALG group than for the OG group (P =0.00). The rate of conversion to laparotomy , the pneumoperitoneum time and the number of recovered lymph nodes were significantly better for the HALG group than for the LAG group (P <0.05). The pain score at day 2 after surgery, intestinal function recovery time, and duration of postoperative hospital stay were not significantly different for the HALG and LAG groups ( P >0.05) but were significantly better for the HALG group than for the OG group (P <0.05). There were significantly fewer postoperative complications for the HALG group than for the LAG and OG groups (P =0.049). According to the results, the “three-step HALG method” incorporates both the thoroughness of the radical OG approach and the minimal invasiveness of the LAG approach for obese patients. Thus, the HALG approach is a relatively safe and extremely feasible surgical procedure for the treatment of these patients.

Effects of laparoscopic radical gastrectomy and the influence on immune function and inflammatory factors

“…Currently, it is believed that laparoscopic radical gastrectomy is notable for minimal trauma and quick recovery after surgery (10)(11)(12). In the present study, when the open radical gastrectomy group was compared with patients undergoing laparoscopic radical gastrectomy, the latter group required more surgical time, but was associated with less blood loss during the operation, which supported a rapid recovery.…”

Reverse rolling-mat type lymph node dissection is the key step to solve the operative difficulties in hand-assisted laparoscopic D2 radical gastrectomy

“…D2 lymphadenectomy was performed according to the Japanese Classification of Gastric Carcinoma (13th edition). After general anesthesia, the patients were positioned supine on the operating table, and the “three-step procedure” was used to implement HALTG [ 14 , 15 ]. The brief procedure is as follows: (1) First step: A 6 to 8 cm exploratory incision below the median xiphoid process of the upper abdomen was made into the abdominal cavity and then a LapDisc hand-assisted device was placed into the opened incision providing surgical field.…”

Hand-Assisted Laparoscopic D2 Radical Gastrectomy: A Promising Surgical Approach

“…From 2008, we have successfully performed more than 600 cases of HALG, which has achieved a satisfactory efficacy. During a large number of clinical practices, we have gradually developed a unique "three-step HALG" [1][2][3][4] and a unique reverse-sheet-folding-like procedure for lymph node dissection.…”

“…For the obese patients, we have published the related research outcomes in Journal of Cancer. 3 For the pattern of lymph node dissection in gastric cancer, we conducted useful studies. Eventually, a simple, unique, and efficient protocol for lymph node dissection, the reverse-sheet-folding-like procedure, was developed.…”