Single Incision Laparoscopic Distal Gastrectomy with D1 beta Lymph Node Dissection for Gastric Cancers

Sang-Hoon Ahn, MD, Do Joong Park, MD, PhD, Sang-Yong Son, MD, Chang-Min Lee, MD, Ju Hee Lee, MD, Hyung-Ho Kim, MD, PhD

Seoul National University Bundang Hospital

Background : Laparoscopic gastrectomy has gained an acceptance for early gastric cancers. This procedure is less invasive than conventional open approaches, Single incision laparoscopic surgery is applied to various abdominal surgical procedures. However, its application for early gastric cancer is rare due to difficulties achieving adequate lymphadenectomy and reconstruction. We report our early experience with single-incision laparoscopic distal gastrectomy with D1+beta lymph node dissection.

Methods : A single vertical 2.5-cm umbilical incision was made, and Glove-port (Inframed, Seoul, Korea) were placed within the umbilicus. Only one 2-mm grasper in the left upper abdomen was used for assistance. Liver retraction was done by combined liver retraction suture. Gastric mobilization and D1+beta lymph node dissection were performed. The stomach and duodenum then were transected intracorporeally using linear staplers. Intracorporeal anastomosis was performed for reconstruction.

Results : All seven single-incision laparoscopic distal gastrectomies with D1+beta lymphadenectomy were performed without any additional trocars or conversion to laparotomy. The median operation time was 228.7min (±56.7, range, 170–350 min). and the median estimated blood loss was 71.7 ml (±63.4, range, 0–100 ml). A median total of 39.7 lymph nodes were retrieved. No serious perioperative complications occurred, and no mortalities were observed..

Conclusions : Our early experience of single-incision laparoscopic distal gastrectomy with D1+beta lymph node dissection showed that it is a feasible and safe procedure for early gastric cancer and provides a favorable cosmetic result.

Session: Poster Presentation

Program Number: P239