Totally laparoscopic gastrectomy using intracorporeally stapler or hand-sewn anastomosis for gastric cancer: a single-center experience of 478 consecutive cases and outcomes

Abstract

BackgroundTotally laparoscopic gastrectomy (TLG) using intracorporeal anastomosis has gradually become mature thanks to the advancements of laparoscopic surgical instruments and the accumulation of operative experience. The goal of this study is to review our institution’s experience with TLG for the treatment of gastric cancer.MethodsA retrospective study was conducted to examine the short-term outcomes of TLG using intracorporeally stapler or hand-sewn anastomosis performed at Sir Run Run Shaw Hospital between March 2007 and June 2015. The details of intracorporeal anastomosis were described, and the clinicopathological data, surgical outcomes, and postoperative complications were evaluated.ResultsFour hundred seventy-eight patients were included in the study. Generally speaking, the patients could be divided into stapler or hand-sewn groups according to whether intracorporeal anastomosis was performed by only hand-sewn technique (n = 97) or only stapling devices (n = 381). For overall patients, the mean operation time and anastomotic time were 225.7 and 30.0 min, respectively. Postoperative complications were observed in 65 patients. All of the patients recovered well without perioperative death by conservative or surgical management.ConclusionsTLG using intracorporeally stapler or hand-sewn anastomosis is a reasonable option for the treatment of gastric cancer, with early data showing acceptable perioperative outcomes.

Intracorporeal hemi-hand-sewn technique for Billroth-I gastroduodenostomy after laparoscopic distal gastrectomy: comparative analysis with laparoscopy-assisted distal gastrectomy

“…On the other hand, other anastomotic procedures using intracorporeal hand-sewn techniques were reported [30][31][32] . Takiguchi et al [30] performed a total laparoscopic method by performing Billroth-I handsewn anastomosis and reported excellent postoperative recovery.…”

Linear-Stapled Side-to-Side Esophagojejunostomy with Hand-Sewn Closure of the Common Enterotomy After Prophylactic and Therapeutic Total Gastrectomy

“…Systems of transoral delivery of the anvil have been developed, but they carry the potential risks of injuring the esophageal mucosa and potential bacterial seeding of the abdominal cavity. [43] The modified Orringer technique described here may have a flatter learning curve based on the pervasive use and familiarity of the Endo GIA™ linear stapler among general surgery practices and academic centers.…”

Short-term outcomes of laparoscopic local resection for gastric submucosal tumors: a single-center experience of 266 patients

“…On the basis of the Risk Assessment Classification presented by Fletcher and colleagues, the GISTs were quadripartite. [10] (National Institutes of Health [NIH] consensus criteria). A skilled pathologist counted mitotic figures for total specimen in 50 high-power fields (HPFs), which were chosen at random.…”

“…However, as to neoplasms located at cardia, especially near the esophagogastric junction (EGJ), or lay to antrum, LEWR increases the risk of generating stenosis or deformity in the gastric inlet or outlet [5]. Based on our extensive laparoscopic gastrectomy (LG) [6–10], we developed laparoscopic transgastric resection (LTR) for tumors located at cardia or antrum to avoid a total, proximal or distal gastrectomy. We herein give notice to our results from these two types of laparoscopic resection methods and also an assessment of the postoperative surgical outcomes to evaluate the feasibility and safety of those procedures.…”