Totally Laparoscopic Total Gastrectomy (TLTG), toward zero anastomotic (esophagojejunostomy) leak. Procedure standardization and application easiness from over 150 cases experiences in single center.

Hitoshi Satodate, Haruhiro Inoue, Shin-ei Kudo

Showa University Northern Yokohama Hospital

Introduction:
Many studies have reported that laparoscopic distal gastrectomy is as safe as open gastrectomy and less invasive than open gastrectomy. However, laparoscopic total gastrectomy is not a generally accepted approach among many surgeons due to technical difficulties and high complication rate. The most feared surgical postoperative complication is certainly the anastomotic leak, it is potentially fatal. The reported anastomotic leak rate for gastrectomy is around 5-10%. In our institution, the leak rate is less than 1% with this procedure. And in recent 100 cases, there was no leak.

Method:
A 12-mm trocar is placed through umbilical incision, and four additional trocars are placed. After thorough resection of the stomach and lymph-nodes, the esophagus is divided with stapler, and transorally inserted anvil (Orvil) is loaded into the esophageal stump. Then the handpiece of EEA stapler is introduced from the umbilical port incision, after inserted via the blind end of a Roux loop. Then the intracorporeal esophagojejunostomy is created.

Results:
We have performed 156 cases of the TLTG with this procedure, and have experienced only one minor anastomotic leakage. No other major problems had occurred. Mean operation time is 242 min.

Conclusion:
Several advantages can be mentioned with this method, compare with other techniques. First, this technique can be relatively easily applied. Second, minimize the use of disposable instruments. Only three linear staplers and one circular stapler are needed. This technique could become the standard methods for reconstruction after TLTG, and facilitate the acceptance of TLTG. But there are several knacks to complete this procedure smoothly. We will show our clinical practice.


Session: Poster Presentation

Program Number: P229

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