Convenience of Adding a Needle Grasper in Single-Incision Laparoscopic Distal Gastrectomy With Billroth I Anastomosis for Clinical Early Gastric Cancer

Current Issues in Reduced-Port Gastrectomy: A Comprehensive Review

“…In 2014, it was also developed into a pure single-port laparoscopic distal gastrectomy, performed using only a single port, without the help of other tools such as a needle grasper [ 13 ]. However, due to the technical difficulties of SILG, cases of adding 1 trocar or needle grasper to a multichannel port have also been reported since 2012 [ 4 14 15 ]. Additionally, 3-port laparoscopic gastrectomy (3PLG) using only 3 trocars is also being performed since 2015 [ 16 ].…”

“…As mentioned earlier, various types of RPG have been introduced and are currently being performed. These types can be categorized into pure SILG, needle grasper-assisted SILG, addition of 1 trocar to a multichannel single-port device, and use of 3 trocars [ 12 13 14 15 16 ]. Because RPGs include many different methods, it is necessary to distinguish and organize the terms.…”

“…Additionally, because the surgeon's instruments enter the navel, pressure is applied to the pancreas, thus increasing the risk of damage. If surgery is performed by inserting a needle grasper (needle grasper-assisted SILG) or trocar (2-port laparoscopic gastrectomy, 2PLG) into the right upper abdomen and one of the operator's instruments enters that area, it is easier to receive assistance from an assistant, and interference between instruments can also be reduced [ 14 15 ]. When 3 trocars are used without a multichannel single-port device, no such assistance is possible; therefore, the operator needs to use excessive traction to create a dissection plane.…”

“…However, because the operator's active instruments are accessed from the patient's right upper abdomen, the pressure applied to the pancreas may be less than that in SILG. Because traction and countertraction are lacking in all types of RPG, a needle grasper or organ retractor can be used to compensate for this [ 15 22 ].…”

“…Until surgeons acquire the necessary skills, they need to select an appropriate candidate to perform RPG and should not hesitate to insert additional ports, if necessary. To compensate for insufficient traction-counter traction mechanism of an RPG, a needle grasper or organ retractor can be used [ 15 22 ].…”