J Gastric Cancer.  2015 Jun;15(2):132-138. 10.5230/jgc.2015.15.2.132.

Solo Intracorporeal Esophagojejunostomy Reconstruction Using a Laparoscopic Scope Holder in Single-Port Laparoscopic Total Gastrectomy for Early Gastric Cancer

• Ahn SH
• Son SY
• Jung DH
• Park YS
• Shin DJ
• Park DJ
• Kim HH

• KMID: 2372361
• DOI: http://doi.org/10.5230/jgc.2015.15.2.132

Abstract

Single-incision laparoscopic total gastrectomy for gastric cancer has recently been reported by Seoul National University Bundang Hospital. However, this is not a popular procedure primarily because of the technical difficulties involved in achieving consistent intracorporeal esophagojejunostomy. At Seoul National University Bundang Hospital, we recently introduced a simple, easy-to-use, low-profile laparoscopic manual scope holder that enables the maintenance of a stable field of view, the most demanding condition in single-port gastrectomy. In this technical report, we describe in detail the world's first solo single-incision laparoscopic total gastrectomy with D1+ lymph node dissection and intracorporeal esophagojejunostomy for proximal early gastric cancer.

Keyword

Stomach neoplasms; Solo surgery; Gastrectomy; Single port; Laparoscopy

MeSH Terms

Gastrectomy*
Laparoscopy
Lymph Node Excision
Seoul
Stomach Neoplasms*

Figure

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  Fig. 1 Position and scope holder placement.

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  Fig. 2 Lymph node dissection in solo single-incision laparoscopic total gastrectomy. (A) The suprapancreatic area including lymph nodes #7, 8a, 9, 11p, and 12a. (B) The splenic hilum area including lymph nodes #10 and 11d.

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  Fig. 3 Esophagus preparation. (A) Transection of the distal esophagus. (B) The stay suture at the mid-portion of the staple line. (C) The opening of the jejunum made using the hook in cutting mode. (D) Confirmation of the exact opening of the esophagus guided by a nasogastric tube.

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  Fig. 4 Semi-loop esophagojejunostomy in solo single-incision laparoscopic total gastrectomy. (A) Inserting the stapler by pulling the jejunum. (B) Inserting the anvil side by pulling the stay suture or the esophagus. (C) A corner stay suture at the near side of the stapling site that can be used during suturing. (D) A barbed suture closure at the far side of the stapling site. (E) A seromuscular suture made using the same barbed thread. (F) Complete view of the solo semi-loop esophagojejunostomy.

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