Wei Wang, Wenjun Xiong, Jin Wan. Guangdong Province Hospital of Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine
In Japanese gastric cancer treatment guidelines, bursectomy (removal of the inner peritoneal surface of the bursa omentalis) may be performed with the aim of removing microscopic tumor deposits in the lesser sac for tumors penetrating the serosa of the posterior gastric wall. Brsectomy is widely performed in open surgery in East Asia. However laparoscopic D2 raidal total gastrectomy with complete bursectomy is technically difficult and rare performed. Herein, we introduce the technique of totally laparoscopic D2 radical total gastrectomy using an outside bursa omentalis approach to achieve complete bursectomy.
First step was identifying the left peritoneum line and dissecting the anterior lobe of transverse mesocolon and the capsule of pancreas from left to right. The superior border of pancreas was exposed and the outside omentalis space was expanded from left to right with the No.4sb, 4sa, 11 and 10 lymph nodes (LNs) dissection. The posterior wall of bursa omentalis was dissected from pancreatic tail to pancreatic neck with the abdominal aorta, celiac trunk and its branches were exposed and the No.2, 7, 8a and 9 lymph nodes were dissected. Exposing the right gastric artery and portal vein, the No.5 and 12a LNs were dissected. Then a piece of guaze was placed at the back of duodenum for introduction. Secondly, the right part of the anterior lobe of transverse mesocolon was separate to expose the duodenum and pancreas head. The right gastroepiploic vessel was ligated at root to dissect No.6 LNs. The capsule of pancreas head was dissected to expand the outside bursa omentalis space and the gauze for introduction was indentified. The two side of outside bursa omentalis space were combined. With the introduction of separated anterior-pancreatic space, the middle part of the anterior lobe of transverse mesocolon was dissected. The third step was separating the anterior wall of the lesser bursa omentalis to dissect No.1, 3 and 5 LNs. The mobilizing and dissecting procedure was finished and complete bursectomy was accomplished. Finally totally laparoscopic Roux-en-Y esophagojejunostomy was performed using a suture-tied-anvil technique.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79931
Program Number: V009
Presentation Session: Gastric
Presentation Type: Video