Boram Lee, MD, Hyung-Ho Kim, Do Joong Park, Sang-Hoon Ahn, Young Suk Park, Yoon Taek Lee. Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
Introduction: Single port laparoscopic distal gastrectomy (SPDG) usually requires an operator and a camera assistant. When performing SPDG, an experienced camera assistant is needed for stable images. However, due to the lack of skilled camera assistants, we started the solo surgery with mechanical camera holder. The aim of the study is to compare the short-term outcomes between solo SPDG and conventional multiport laparoscopic distal gastrectomy (MLDG) for gastric cancer.
Methods: From January 2014 to December 2016, a total of 938 consecutive patients with early gastric cancer underwent solo SPDG (n=103) and MLDG (n=835) performed by same surgical team. Solo SPDG can be defined as practice in which a surgeon operates alone using camera holder. MLDG usually requires two or three surgical assistants. The inclusion criteria in this study were (i) pathologic proven stage I-II gastric cancer (ii) no other malignancy (iii) more than D1 lymph node dissection (iv) R0 surgery. One-to-two propensity score matching was performed to compensate for the differences between two groups.
Results: After the propensity score matching, solo SPDG (n=99) and MLDG (n=198) patients were selected. Mean operation time (120 ± 35.3 vs 178 ± 53.4 mins, p=0.001) and estimated blood loss (EBL) (24.6 ± 47.4 vs 46.7 ± 66.5 ml, p=0.001) were signi?cantly lower in the solo SPDG group than in the MLDG group. The hospital stay and the use of pain control were similar between the two groups. Although the initiation of semi fluid diet was similar, the time to first flatus was earlier in the solo SPDG. (3.04 ± 0.85 vs 3.39 ± 0.78 days, p=0.001). The postoperative inflammatory markers (White blood cells, Serum C-reactive proteins) were similar in both groups. The early (<30day) complication rates in solo SPDG and MLDG were 7.1% and 3.0% (p=0.13). The late (≥30days) complication rates in solo SPDG and MLDG were 7.1% and 3.5% (p=0.24).
Conclusion: This study demonstrated that solo SPDG performed by experienced laparoscopic surgeons is safe and feasible for early gastric cancer comparing with MLDG. Solo SPDG is expected to have promising potential treatment method for early gastric cancer.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87468
Program Number: P699
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster