Purpose: Conventional straight-shaped laparoscopic surgical instruments have limitations that, unlike robotic surgery, the wrist joint cannot be used. This study aimed to analyze the short-term safety and feasibility of ArtiSential (Livsmed), a new articulating laparoscopic instrument, which obviates the limitations of conventional laparoscopic surgery and allows the wrist joint to be used freely over 360° as in robotic surgery. Methods:The study included patients who underwent conventional laparoscopy or laparoscopy with the ArtiSential instrument. Patients who underwent laparoscopic gastrectomy for primary gastric adenocarcinoma in our institution were retrospectively reviewed. The groups were propensity score matched in a 1:1 ratio. Primary endpoint was incidence of early postoperative complication (postoperative 30-day morbidity and mortality) and secondary endpoints were operative outcomes.Results: A total of 327 patients (147 of the conventional group and 180 of the ArtiSential group) were propensity score matched. After propensity score matching was performed, each group comprised of 122 patients. Both groups were comparable with regard to operation time, estimated blood loss, number of retrieved lymph nodes, and length of hospital stay. The ArtiSential group had a faster time to a fluid diet (2.6 ± 1.3 days vs. 2.3 ± 0.6 days, p = 0.015). There was no statistically significant difference in early postoperative complications between the two groups (the conventional group, 23.0%; the ArtiSential group, 26.2%; p = 0.656). Conclusion:The current study showed that the use of ArtiSential is a safe and feasible option without increasing operation time, length of hospital stay, and intraoperative bleeding.

Laparoscopic sleeve gastrectomy is the most frequently performed surgical intervention in patients with morbid obesity. Single-port sleeve gastrectomy (SPSG) and reduced-port sleeve gastrectomy (RPSG) are increasingly reported in the literature. This study compared the short-term outcomes of SPSG, RPSG, and conventional laparoscopic sleeve gastrectomy (CLSG). This is a single-center retrospective study of 238 morbidly obese patients, of whom 148 (62.2%) patients completed follow-up one year after surgery. Propensity score matching was performed on factors influencing the choice of approach, and fifty patients from the SPSG + RPSG and CLSG groups were successfully matched. The groups were comparable in postoperative weight loss, morbidity, pain, and resolution of obesity-related comorbidities. The percentage of excess weight loss after one year was 90.0% in the SPSG + RPSG group and 75.2% in the CLSG group (P < 0.001). Complication rates showed no significant difference. The CLSG group was superior in dyslipidemia remission (17 [37.0%] vs. 28 [63.6%], P = 0.018) in the total cohort; however, this difference disappeared after matching. Our results suggest that single-port and reduced-port approaches could be alternative choices for selected patients. As our study was limited by its retrospective nature and potential selection bias, further studies are necessary to set standardized guidelines for SPSG.

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According to GLOBOCAN 2018, there were over 1 000 000 new cases of GC in 2018 and an estimated 783 000 deaths, making it the fifth most frequently diagnosed cancer and the third leading cause of cancer death worldwide. 1 The traditional treatment option for GC is surgical resection, which includes gastrectomy with D2 lymph node dissection after laparotomy. However, several less invasive procedures and minimally invasive surgeries (MISs) have been developed to reduce the invasiveness of surgery and improve patients' quality of life. In 1994, Dr. Seigo Kitano first introduced laparoscopyassisted distal gastrectomy (LADG) for early gastric cancer (EGC).Since then, based on many studies and clinical trials, the laparoscopic approach has become increasingly established in GC surgery. 2 In addition, even more popular than LADG, a totally laparoscopic gastrectomy technique has been developed to reduce surgical wound and surgical stress compared to laparoscopic-assisted methods. In 2009, Ikeda et al reported the advantages of totally laparoscopic distal gastrectomy (TLDG) over LADG as less invasive, secure ablation of the tumor with the stomach, and safe anastomosis. 3 Chen et al reported that TLDG had a longer surgery time but less bleeding and shorter hospitalization than open gastrectomy (OG) in a systematic review including one randomized controlled trial (RCT) and 13 observational studies. 4 In eastern Asian countries, several study groups have been established as a platform to organize and conduct prospective RCTs in each country; for example, the Japanese Clinical Oncology Study Group (JCOG) in Japan, the Korean Laparoscopic Gastrointestinal Surgical Study Group (KLASS) in South Korea, and the Chinese Laparoscopic Gastrointestinal Surgical Study Group (CLASS) in China to evaluate the safety and feasibility of MIS on GC. In Korea, the KLASS-01 trial has proven the efficacy of laparoscopic distal gastrectomy (LDG) vs open subtotal gastrectomy for clinical stage I GC with better short-term outcomes and equivalent long-term survival. 5,6 In Japan, similar results have been demonstrated for LDG vs open distal gastrectomy for clinical stage IA/IB GC in the JCOG 0912 trial. 7,8 In China, the safety of laparoscopic total gastrectomy