Solo single-incision laparoscopic total gastrectomy with D1+ lymph node dissection for proximal early gastric cancer.

Sang Hoon Ahn, Do Joong Park, PhD, Hyung-Ho Kim, PhD. Department of Surgery, Seoul National University Bundang Hospital

Introduction
Single-incision total gastrectomy was reported first time in 2013 by our institution. However, it is difficult to perform intracoporeal esophagojejunostomy because of clashes between laparoscopic intruments and scope. Herein, we present the solo pure single-incision laparoscopic total gastrectomy (SITG) with D1+ lymph node dissection for early gastric cancer.
Methods
From Semptember 2013 to November 2013, 2 patients with early gastric cancer underwent solo SITG with D1+ lymph node dissection at Seoul National University Bundang Hospital. We use a commercial manual laparoscopic scope holder (laparostat, CIVCO, Iowa, U.S.), 10mm flexible videoscope through the 2.5cm umbilical incision. All procedures were done by the operator alone. Usual D1+ lymph node dissection and total gastrectomy was performed without any additional support. After the specimen confirmation, modified semi-loop esophago-jejunostomy using unaided stapling closure method was made by laparoscopic linear staplers.
Results
The operations were finished without any accidental event or laparoscopic conversion or additional ports. Each patient's body mass index was 22.3 and 25.6 kg/m2. The operative time was 190 and 215 minutes, respectively. The Estimated blood loss was 50 and 100 mL, respectively. Final pathologic outcomes were pT1bN0 (0/63) and pT1bN2(4/99), respectively. All patients were discharged with no complication and complaints on the postoperative sixth day. The postoperative cosmetic result from this operation was excellent.
Conclusions
These two cases demonstrated the technical possibility of solo SITG and modified semi-loop esophagojejunostomy. Further experience and research are required to confirm the safety and feasibility of solo SITG.