D2 lymph node dissection for early gastric cancer was popularized by the Japanese, though it is still controversial. The adequacy of laparoscopic node harvest remains doubtful. In this video, we present a laparoscopic D2 dissection with total gastrectomy and jejunal pouch anastamosis.
Methods: The patient is placed supine with legs apart so that the surgeon stands between the legs. The dissection is commenced by disconnecting the greater omentum off the transverse colon, proceeding to clear the nodes at the splenic hilum (#10), gastrocolic (#6), nodes around superior mesenteric vein (#14v), and subpyloric nodes. Next, the duodenum was transected and the hepatoduodenal (#12a & 5), celiac axis (#9), and nodes around portal vein (#8p) were cleared. The nodes around left gastric artery (#7) were then cleared, and the dissection was continued up to the median arcuate ligament to clear nodes at the gastroesophageal junction (#1& 2). Nodes around the splenic artery (#11) were cleared. At this point, the esophagus is divided at the junction with a stapler. Esophageal-pouch anastomosis was performed laparoscopically, while the pouch construction was done extracorporeally.
Conclusion: Laparoscopic D2 dissection with total gastrectomy and jejunal pouch anastomosis is safe and feasible. It is comparable with the open technique regarding lymph node harvest and superior because of lower morbidity.
Session: Podium Video Presentation
Program Number: V004