Completely Laparoscopic Total Gastrectomy with Linear-stapled Anastomosis

Hiroshi Okabe, MD, Kazutaka Obama, MD, Eiji Tanaka, MD, Shigeru Tsunoda, MD, Shigeo Hisamori, MD, Yoshiharu Sakai, MD

Department of Surgery, Kyoto University, Japan

INTRODUCTION: Although number of patients undergoing laparoscopic gastrectomy is rapidly increasing in eastern Asia, laparoscopic total gastrectomy is not popular yet. Difficulty in reconstruction and lymph node dissection in deeper area is a major reason. We established an approach to deep area around the splenic hilum and introduced intracorporeal linear-stapled anastomosis to perform completely laparoscopic total gastrectomy securely.

1) The gastrosplenic ligament is divided using a sealing device, while the operation table is tilted to the right. It is important to identify the splenic upper pole to determine the proper dissection line. The gastrophrenic ligament is cut from the caudal side, and then the uppermost branch of the short gastric vessels is divided.
2) After transecting the duodenum, we approach to the space behind the esophagus from the right side (Medial approach). By the blunt dissection between the perigastric fat tissue and the fusion fascia, the fundus is completely mobilized. After the transection of the esophagus and division of the left gastric artery, splenic lymph node dissection is done under a better visualization.
3) Y-anastomosis is performed using linear stapler and hand-sewn closure of the entry hole. Then, the Roux-limb is brought up via an ante-colic route and esophagojejunal anastomosis is performed with functional end-to-end anastomosis using 45mm linear staplers. The Petersen’s space is closed.

RESULTS: Completely laparoscopic total gastrectomy was successfully performed in 114 out of 115 patients. One open conversion was done for splenic bleeding (1.1%). Mean blood loss was 153g. Mean operation time was 376 min. Extnent of lymphadenectomy was D1+ in 83, D2 in 31 patients. Postoperative complication was observed in 19 patients (16.7%). Mortality was 1.7%.

CONCLUSION: Completely laparoscopic total gastrectomy with linear-stapled anastomosis is technically feasible with excellent short-term outcome.

Session: Video Channel Day 1

Program Number: V041

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