Respiratory Function after Laparoscopic Distal Gastrectomy—An Index of Minimally Invasive Surgery

Tanimura, Shinya; Higashino, Masayuki; Fukunaga, Yosuke; Kishida, Satoru; Ogata, Akihito; Fujiwara, Yushi; Osugi, Harushi

doi:10.1007/s00268-005-0115-9

Cited by 40 publications

(29 citation statements)

References 13 publications

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“…The smaller wound means a better cosmetic result and may lead to less invasiveness. In addition, purely laparoscopic surgery can provide a safe anasomosis independently of the patient's habitus and brings about good postoperative respiratory function [14]. The delta-shaped anastomosis is safe in terms of minimal postoperative morbidity, and it is easy to perform, at least with the support of a well-experienced surgeon.…”

Section: Discussionmentioning

confidence: 99%

The delta-shaped anastomosis in laparoscopic distal gastrectomy: analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy

et al. 2011

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Background We developed a new method of intracorporeal gastroduodenostomy, the delta-shaped anastomosis, in which only endoscopic linear staplers are used. In this report, we present the short-and long-term outcomes of our initial experience with this procedure. Methods We retrospectively analyzed 100 consecutive gastric cancer patients who underwent the delta-shaped anastomosis procedure from May 2001 to November 2006. All of them underwent a laparoscopic distal gastrectomy with regional lymph node dissection. Quality of life was assessed with a questionnaire 6 months or more postoperatively, and the gastric remnant was evaluated by endoscopy one year following the surgery. Results Eight surgeons successfully performed the deltashaped anastomosis without any conversion to laparotomy. The learning curve for all surgeons was steep and the mean time for the anastomosis was 13 min. Only one patient developed an anastomotic leak, and the leak was minor. Sixty-five patients tolerated a 1500 kcal/day soft diet at the time of discharge. The mean follow-up period was 54.9 months. Only one patient reported symptoms indicative of dumping. Two patients were diagnosed with reflux esophagitis, and approximately 70% had evidence of bile reflux, but severe gastritis of the remnant stomach on endoscopy was uncommon. Conclusions The wide lumen of the delta-shaped anastomosis led to early, adequate postoperative oral intake without a significant incidence of dumping syndrome. The delta-shaped anastomosis is safe and simple and provides satisfactory postoperative results.

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Section: Discussionmentioning

confidence: 99%

The delta-shaped anastomosis in laparoscopic distal gastrectomy: analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy

et al. 2011

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“…The minimally invasive nature of laparoscopic gastrectomy (LG) has been reported in numerous studies [1][2][3][4]. Although laparoscopic surgery characteristically causes little postoperative pain, some patients report intense pain after LG, whereas others report almost no pain after open gastrectomy.…”

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confidence: 99%

Assessment of pain by face scales after gastrectomy: comparison of laparoscopically assisted gastrectomy and open gastrectomy

et al. 2008

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“…However, LADG is technically a more complex operation compared with other laparoscopic procedures and still in the development phase. Because laparoscopic gastrectomy has been reported to have substantial advantages over conventional operations, such as less postoperative pain, faster recovery, and better cosmetic results, many gastric surgeons have a high level of interest in learning the technique [8][9][10][11]. However, thus far there have been few published descriptions on the learning process associated with LADG [14][15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

“…LADG with regional lymph node dissection has recently become a treatment option for patients with early gastric cancer [6,7]. LADG has many advantages over conventional open distal gastrectomy (ODG): less invasiveness, blood loss, and postoperative pain, faster recovery, shortened hospital stay, and better cosmetic results [8][9][10][11]. Moreover, because long-term survival rates in patients with early gastric cancer after LADG have been reported to be similar to those of ODG [12,13], many Japanese surgeons have adopted a laparoscopic approach to distal gastrectomy.…”

Section: Introductionmentioning

confidence: 99%

Direct Instruction by an Experienced Surgeon Can Shorten the Learning Curve for Laparoscopic-Assisted Distal Gastrectomy

Takemura¹,

Mayumi²,

Ikebe³

et al. 2013

IJCM

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Aim: Laparoscopy-assisted distal gastrectomy (LADG) with regional lymph node dissection is a treatment option for patient with early gastric cancer. However, LADG is a technically complex and advanced procedure, which is challenging for inexperienced surgeons. In this report, we retrospectively evaluated the learning curve for LADG of a single surgeon with no previous experience in LADG and the usefulness of direct instruction by a surgeon experienced in LADG in shortening the learning curve. Patients and Methods: This study was analyzed 80 consecutive patients, who underwent LADG by a single surgeon (first assistant in 10 cases and operator in 70 cases) between January 2008 and December 2012. Patients were divided into 3 sequential groups of 10 (training period), 30 (learning period), and 40 (operating period) cases in each group. Median operation time and estimated blood loss for these 3 groups were determined. Other learning indicators, including transfusion requirement, postoperative complications, number of lymph node harvested, and rate of conversion open gastrectomy, were also evaluated. Results: During the training period, median operation time and estimated blood loss were 219.5 min and 83.0 ml, respectively. During the learning period, the operation time was significantly longer than that of training period. In the operating period, the operation time was significantly lesser than that during the learning period. However, the operation time was not different from that during the training period and reached a plateau. The estimated blood loss during the operating period was significantly lesser than that during the learning period. The difference in the number of lymph nodes retrieved between each group was not significant. Conclusions: Direct instructions by an experienced surgeon can decrease the number of cases required for learning. Because LADG is technically more complex than other laparoscopic procedures, standardization of LADG and an effective training system for performing it should be established.

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Respiratory Function after Laparoscopic Distal Gastrectomy—An Index of Minimally Invasive Surgery

Abstract: Although it may be a complicated technique, totally laparoscopic distal gastrectomy is considered a minimally invasive procedure for gastric cancer from the viewpoint of postoperative respiratory function.

Cited by 40 publications

References 13 publications

The delta-shaped anastomosis in laparoscopic distal gastrectomy: analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy

The delta-shaped anastomosis in laparoscopic distal gastrectomy: analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy

Assessment of pain by face scales after gastrectomy: comparison of laparoscopically assisted gastrectomy and open gastrectomy

Direct Instruction by an Experienced Surgeon Can Shorten the Learning Curve for Laparoscopic-Assisted Distal Gastrectomy

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