A novel abdominal wall-lifting device for gasless laparoscopic gastrectomy: the initial experience of a serial cases

Jianxin Cui, Canrong Lu, Hongqing Xi, Yingwen Cai, Shibo Bian, Liangang Ma, Yunhe Gao, Bo Wei, Lin Chen. Department of General Surgery, Chinese People’s Liberation Army of General Hospital

Background: Open surgery for gastric cancer (GC) can cause serve surgery-related injury, and CO2 pneumoperitoneum laparoscopic surgery may bring CO2-related complications, such as respiratory and circulatory system complications. Though reducing these adverse effects, present gasless laparoscopic techniques doesn’t suit for complicated abdominal surgery due to inadequate operative space. Therefore, we developed a novel abdominal wall-lifting device for gasless laparoscopic gastrectomy.

Methods: We described a novel self-designed abdominal wall-lifting device using in gasless laparoscopic gastrectomy. We performed this gasless technique in three pigs to verify its feasibility and performed it in ten old patients with advanced GC, recording and analyzing the operation factors and short-term outcomes.

Results: Three pigs underwent laparoscopic gastrectomy using the device with satisfactory operative space and no conversion to open operation. Ten GC patients, with a mean age of 75.8 years and mean BMI of 23.3 kg/m2, underwent laparoscopic gastrectomy using this gasless technique. The operation time, intraoperative blood loss, times of wiping the lens, harvested lymph nodes were 218.9 ± 47.9 min, 210 ± 52.3 ml, 3.6 ± 0.9, 35.1 ±4.6 separately. The time of first flatus was 2.8 ± 0.75 days and the length of postoperative hospital stay was 8.5 ± 1.6 days. There were no conversion and massive hemorrhages, related injuries or other complications during the operation.

Conclusions: These preliminary outcomes indicate that this novel abdominal wall-lifting device could provide sufficient exposure for gasless gastrectomy technique, which can hybridize the advantages of both the traditional open resection and laparoscopic surgery.

Key words: Instrument design; Gasless laparoscopic gastrectomy; Innovation

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