Initial experience of single-incision plus one port left-side approach totally laparoscopic distal gastrectomy with uncut Roux-en-Y reconstruction

Abstract

BACKGROUND Single incision plus one port left-side approach (SILS+1/L) totally laparoscopic distal gastrectomy (TLDG) is an emerging technique for the treatment of gastric cancer. Reduced port laparoscopic gastrectomy has a number of potential advantages for patients compared with conventional laparoscopic gastrectomy: relieving postoperative pain, shortening hospital stay and offering a better cosmetic outcome. Nevertheless, there are no previous reports on the use of SILS+1/L TLDG with uncut Roux-en-Y (uncut R-Y) reconstruction. AIM To investigate the initial feasibility of SILS+1/L TLDG with uncut Roux-en-Y digestive tract reconstruction (uncut R-Y reconstruction) to treat distal gastric cancer. METHODS A total of 21 patients who underwent SILS+1/L TLDG with uncut R-Y reconstruction for gastric cancer were enrolled. All patients were treated at The Second Hospital of Shandong University. Reconstructions were performed intracorporeally with 60 mm endoscopic linear stapler and 45 mm no-knife stapler. The clinicopathological characteristics, surgical details, postoperative short-term outcomes, postoperative follow-up upper gastrointestinal radiography findings and endoscopy results were analyzed retrospectively. RESULTS All SILS+1/L operations were performed by SILS+1/L TLDG successfully. The patient population included 13 men and 8 women with a mean age of 48.2 years (ranged from 40 years to 70 years) and median body mass index of 22.8 kg/m 2 . There were no conversions to open laparotomy, and no other port was placed. The mean operation time was 146 min (ranged 130-180 min), and the estimated mean blood loss was 54 mL (ranged 20-110 mL). The mean duration to flatus and discharge was 2.3 (ranged 1-3.5) and 7.3 (ranged 6-9) d, respectively. The mean number of retrieved lymph nodes was 42 (ranged 30-47). Two patients experienced mild postoperative complications, including surgical site infection (wound at the navel incision) and mild postoperative pancreatic fistula (grade A). Follow-up upper gastrointestinal radiography and endoscopy were carried out at 3 mo postoperatively. No patients experienced moderate or severe food stasis, alkaline gastritis or bile reflux during the follow-up period. No recanalization of the biliopancreatic limb was found. CONCLUSION SILS+1/L TLDG with uncut R-Y reconstruction could be safely performed as a reduced port surgery.

Tranditional Roux-en-Y vs Uncut Roux-en-Y in Laparoscopic Distal Gastrectomy: a Randomized Controlled Study

“…According to a previous study, closing the afferent loop jejunum may not result in permanent healing between the mucosa and the mucosa, which is the main reason for the recanalization of the bowel. [29][30][31] This finding indicates that the linear stapler is not complete enough to close the afferent limb jejunum and needs to be further improved. Some scholars have proposed different methods of closing the afferent loop, and it has been reported that ligation with a 7-gauge silk thread can effectively reduce the recanalization rate.…”

Feasibility and preliminary experience of single-incision plus one-port laparoscopic total gastrectomy with Overlap esophagojejunostomy for gastric cancer: A study of 10 cases

“…Reduced-port laparoscopic surgery (RPS) and single-incision laparoscopic surgery (SILS) have become increasingly popular ( 12 ). As an alternative method to increase the feasibility and reduce the technical challenges of pure SILS, the single-incision plus one-port laparoscopic surgery (SILS + 1) technique has been gradually applied by an increasing number of surgical teams in recent years ( 13 , 14 ). Regarding the application of SITG + 1, most studies have only observed the short-term efficacy of SITG + 1 in distal early gastric cancer ( 5 , 15 , 16 ).…”

Reduced-port laparoscopic distal gastrectomy in obese gastric cancer patients

“…The continuous developments in laparoscopic technology and increasing experience has meant that an increasing number of surgeons are adopting the minimally invasive approach. Many studies have introduced various methods of less invasive laparoscopic gastrectomy, such as reduced-port, dual-port, and single-port laparoscopic gastrectomy, which have contributed to the feasibility of the procedure [ 19 – 22 ]. However, concerns about adopting these procedures in obese patients remain due to technical difficulties and possible postoperative complications.…”