UMUT BARBAROS, Associated Professor, AZIZ SÜMER, Registrar, TUGRUL DEMIREL, Registar, RAMON VILLALONGA, Professor, AHMET DINCCAG, Professor, RIDVAN SEVEN, Professor, SELCUK MERCAN, Professor. Istanbul University, Istanbul Faculty of Medicine, Department of General Surgery
28 years old female was administered with epigastric pain. Physical examination was completely normal. Laboratory results revealed a mild anemia with Htc level of 30 %. Gastroscopy revealed a prepiloric antral ulcer in 4 cm diameter. Multiple endoscopic punch biopsies reported adenocarcinoma. Single incision laparoscopic distal subtotal gastrectomy with D2 level lymph node dissection was planned. D2 dissection is performed according to the criteria of JGCA. The patient is placed in the supine position with head-up tilt. Pneumoperitoneum of 13 mmHg is achieved through trasnumbilical single incision laparoscopy trocar (SILS, Tyco Healthcare Group, Norwalk, CT). No more trocar was added. Dissection is performed with roticulated dissector, hook and 5 mm Ligasure. The stomach and peritoneal cavity are carefully inspected to rule out distant metastasis or carcinosis. Procedure lasted 240 minutes. No per or postoperative complication occurred. During postoperative period oral intake started on 3rd postoperative day with liquid diet and patient was discharged on 5th postoperative day after the removal of drains. Pain scores withVisual Analoge Scale (VAS) on the 1th , 2nd and 3rd postoperative days were 4, 3 and 2 respectively. Pathology result was adenocancer of antrum that invaded muscular layer with no metastatic lymph nodes (26 lymph nodes) (pT2N0).
In well- experienced centers, with appropriate equipment, advanced surgical proceures like radical subtotal gstrectomy could be performed. However question fo should be performed only can be replied after prospective randomized studies.
Program Number: P247