Feasibility and Potential of Reduced Port Surgery for Total Gastrectomy With Overlap Esophagojejunal Anastomosis Method

Abstract

Purpose Reduced port surgery (RPS) for gastric cancer has been frequently reported in distal gastrectomies but rarely in total gastrectomies. This study aimed to determine the feasibility of 3-port totally laparoscopic total gastrectomy (TLTG) with overlapping esophagojejunal (EJ) anastomosis. Materials and Methods A total of 81 patients who underwent curative TLTG for gastric cancer (36 and 45 patients with 3-port and 5-port TLTG, respectively) were evaluated. All 3-port TLTG procedures were performed with the same method as 5-port TLTG, including EJ anastomosis with the intracorporeal overlap method using a linear stapler, except for the number of ports and assistants. Short-term outcomes, including the number of lymph nodes (LNs) harvested by station and postoperative complications, were analyzed retrospectively. Results Clinical characteristics were not significantly different among the groups, except that the 3-port TLTG group was younger and had a lower rate of pulmonary comorbidity. There were no cases of open conversion or additional port placement. All operative details and the number of harvested LNs did not differ between the groups, but the rate of suprapancreatic LN harvest was higher in the 3-port TLTG group. No significant differences were observed in the overall complication rates between the 2 groups. Conclusions Three-port TLTG with overlapping EJ anastomoses using a linear stapler is a feasible RPS procedure for total gastrectomy to treat gastric cancer.

Comparison efficacy and safety of total laparoscopic gastrectomy and laparoscopically assisted total gastrectomy in treatment of gastric cancer

“…In previous studies, two methods of in vivo esophagojejunostomy were introduced, including manual suturing and mechanical suturing (linear stapling and circular stapling)[ 19 ]. Using linear staplers for reconstruction inside the body during endoscopy can make tension-free anastomosis possible, preventing damage to nearby structures[ 20 ]. Unlike circular staplers, linear staplers can be inserted into the abdominal cavity through a cannula hole (Tocar) to complete digestive tract reconstruction without the need for an auxiliary incision.…”

Influence of reduced-port laparoscopic surgery on perioperative indicators, postoperative recovery, and serum inflammation in patients with colorectal carcinoma

“…Reduced-port laparoscopic surgery (RPLS) implements an auxiliary incision combined with a single-port protocol. Port reduction (final two ports) is achieved by combining two auxiliary operation ports and one observation port in the auxiliary incision and then operating alongside the main operation port to achieve laparoscopic radical resection of CRC[ 9 , 10 ]. This surgical modality is minimally invasive and less labor-intensive[ 11 ].…”