Koji Hattori, MDPhD, Takashi Ohmura, MDPhD, Yuji Koba, MD, Ken Kawamoto, MD, Yasuhiro Takemoto, MD. Higashiyamato Hospital
Since 2009 we had performed Single Incision Laparoscopic Cholecystectomy in 200 cases. We recognize this procedure for patients to prefer to. So in a few cases we tried to perform Laparoscopic Distal Gastrectomy for early gastric cancers with the procedures of Single Incision Laparoscopic Surgery. But these procedures have several problems for example difficult handling without keeping of triangular formation and high cost. We should consider to design the well-balanced methods between patients satisfaction and procedures difficulties and cost. Then we had constructed the new procedures with the concept of Reduced Port Surgery and some ideas. So we compared those procedures of Reduced Port Laparoscopic Distal Gasrectomy(RPLDG:n=11) with ones of Usual 5 port Laparoscopic Distal Gasrectomy(5PLDG:n=12) in the retrospective study. Furthermore, some comparisons were made with those in several cases of Single Incision Laparoscopic Distal Gasrectomy(SILDG:n=2).
The study enrolled 23 patients who were diagnosed clinical stage ?~? and were operated from April 2009 to June 2013 by author. Data measures were operative time, estimated blood loss, length of hospital stay, adverse events, conversions to 5PLDG or laparotomy, pain and patient satisfaction.
RPLDG:We make a 25mm vertical incision in the navel. Through the incision we insert two 5mm ports, for the left hand forceps and the scope. And we make a left middle abdominal incision for a 12mm port using the right hand forceps or the stapler.
We mainly use a oblique-viewing endoscope and straight forceps. So we can prevent the scope and the left hand forceps from interfering in each other. Because the right hand forceps is inserted at the separated position from the navel incision, without using bent forcepses we are able to work under keeping the triangular formation. One or two needle devices usually are required to revolve the organs. After cutting the stomach by linear staplers, the specimen is taken out through the navel wound. And Billroth ? reconstruction is performed with Delta anastomosis procedure under laparoscope.
No cases in the both groups had adverse events and were converted to other laparoscopic approaches or laparotomy. The two study groups did not differ in terms of patient demographics.
The RPLDG group had a statistically significant longer operative time than the 5PLDG group (301 vs 248min.), by the way SILDG group (348min.) had a longest time than both groups, but no difference in operative blood loss and hospital stay. And there was no difference in the pain score. After 3months later from operation abdominal scars of all patients in the RPLDG group were hardly recognized and these patients had grate satisfactions with their surprises. Both groups were almost same cost to use disposable goods.
Conclusion / Perspective
Compared with 5PLDG, RPLDG is a feasible approach with comparable operative outcomes. We think that longer operative time of RPLDG group is acceptable and RPLDG is well-balanced procedures.