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Solo Intracorporeal Esophagojejunostomy Reconstruction Using a Laparoscopic Scope Holder in Single-Port Laparoscopic Total Gastrectomy for Early Gastric Cancer.

Ahn SH, Son SY, Jung do H, Park YS, Shin DJ, Park do J, Kim HH - J Gastric Cancer (2015)

Bottom Line: However, this is not a popular procedure primarily because of the technical difficulties involved in achieving consistent intracorporeal esophagojejunostomy.At Seoul National University Bundang Hospital, we recently introduced a simple, easy-to-use, low-profile laparoscopic manual scope holder that enables the maintenance of a stable field of view, the most demanding condition in single-port gastrectomy.In this technical report, we describe in detail the world's first solo single-incision laparoscopic total gastrectomy with D1+ lymph node dissection and intracorporeal esophagojejunostomy for proximal early gastric cancer.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

ABSTRACT
Single-incision laparoscopic total gastrectomy for gastric cancer has recently been reported by Seoul National University Bundang Hospital. However, this is not a popular procedure primarily because of the technical difficulties involved in achieving consistent intracorporeal esophagojejunostomy. At Seoul National University Bundang Hospital, we recently introduced a simple, easy-to-use, low-profile laparoscopic manual scope holder that enables the maintenance of a stable field of view, the most demanding condition in single-port gastrectomy. In this technical report, we describe in detail the world's first solo single-incision laparoscopic total gastrectomy with D1+ lymph node dissection and intracorporeal esophagojejunostomy for proximal early gastric cancer.

No MeSH data available.


Related in: MedlinePlus

Position and scope holder placement.
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Figure 1: Position and scope holder placement.

Mentions: Since we reported the details of SITG in a previous paper, the SITG with D1+ LND is described briefly here.10 The only point of difference is that in the present case series, we used a laparoscopic scope holder (Laparostat) instead of a scopist (i.e., solo surgery). The patient was placed in the lithotomy position with reverse Trendelenburg positioning. However, the hip and knee joints were straightened and not bent so as not to limit the instruments' movements. The surgeon sat between the patient's legs. The scope holder was place on the left side rail of the operating table and covered by a sterile plastic bag (Fig. 1). This scope holder has a low profile, providing more working space for the surgeon with no interference between surgeon and scopist and with minimal clashes between the instruments and scope near the single port, which is in contrast to the conditions associated with additional human scope manipulation. A commercial 4-hole single port (Gloveport; Nelis, Bucheon, Korea) was inserted into a longitudinal 2.5-cm long transumbilical incision. The abdominal cavity was insufflated with carbon dioxide at a pressure of 11 to 13 mmHg. No additional assistant port was used. No assistant or scopist was present in any of the surgeries. We used a 10-mm flexible high-definition laparoscopic scope (Endoeye flexible HD camera system; Olympus Medical Systems Corp., Tokyo, Japan) that was manipulated by the surgeon. The conventional laparoscopic grasper was used in nearly all procedures while the curved long grasper was used for single-port surgery (Olympus Medical System Corp.) when operating on the lesser curvature side, including suprapancreatic LND. We used a laparoscopic automatic linear stapler (I-drive 45 Purple and 60 Purple; Covidien, Minneapolis, MN, USA). We performed routine total gastrectomy with D1+ LND (1; 2; 3; 4sa, sb, d; 5; 6; 7; 8a; 9; 11p, 11d; and 12a), including partial omentectomy (Fig. 2). After complete exposure of the esophagus by division of the anterior and posterior vagus nerves, the esophagus was transected using a linear stapler (Fig. 3A). The specimen was delivered through the single umbilical incision without any extension.


Solo Intracorporeal Esophagojejunostomy Reconstruction Using a Laparoscopic Scope Holder in Single-Port Laparoscopic Total Gastrectomy for Early Gastric Cancer.

Ahn SH, Son SY, Jung do H, Park YS, Shin DJ, Park do J, Kim HH - J Gastric Cancer (2015)

Position and scope holder placement.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496440&req=5

Figure 1: Position and scope holder placement.
Mentions: Since we reported the details of SITG in a previous paper, the SITG with D1+ LND is described briefly here.10 The only point of difference is that in the present case series, we used a laparoscopic scope holder (Laparostat) instead of a scopist (i.e., solo surgery). The patient was placed in the lithotomy position with reverse Trendelenburg positioning. However, the hip and knee joints were straightened and not bent so as not to limit the instruments' movements. The surgeon sat between the patient's legs. The scope holder was place on the left side rail of the operating table and covered by a sterile plastic bag (Fig. 1). This scope holder has a low profile, providing more working space for the surgeon with no interference between surgeon and scopist and with minimal clashes between the instruments and scope near the single port, which is in contrast to the conditions associated with additional human scope manipulation. A commercial 4-hole single port (Gloveport; Nelis, Bucheon, Korea) was inserted into a longitudinal 2.5-cm long transumbilical incision. The abdominal cavity was insufflated with carbon dioxide at a pressure of 11 to 13 mmHg. No additional assistant port was used. No assistant or scopist was present in any of the surgeries. We used a 10-mm flexible high-definition laparoscopic scope (Endoeye flexible HD camera system; Olympus Medical Systems Corp., Tokyo, Japan) that was manipulated by the surgeon. The conventional laparoscopic grasper was used in nearly all procedures while the curved long grasper was used for single-port surgery (Olympus Medical System Corp.) when operating on the lesser curvature side, including suprapancreatic LND. We used a laparoscopic automatic linear stapler (I-drive 45 Purple and 60 Purple; Covidien, Minneapolis, MN, USA). We performed routine total gastrectomy with D1+ LND (1; 2; 3; 4sa, sb, d; 5; 6; 7; 8a; 9; 11p, 11d; and 12a), including partial omentectomy (Fig. 2). After complete exposure of the esophagus by division of the anterior and posterior vagus nerves, the esophagus was transected using a linear stapler (Fig. 3A). The specimen was delivered through the single umbilical incision without any extension.

Bottom Line: However, this is not a popular procedure primarily because of the technical difficulties involved in achieving consistent intracorporeal esophagojejunostomy.At Seoul National University Bundang Hospital, we recently introduced a simple, easy-to-use, low-profile laparoscopic manual scope holder that enables the maintenance of a stable field of view, the most demanding condition in single-port gastrectomy.In this technical report, we describe in detail the world's first solo single-incision laparoscopic total gastrectomy with D1+ lymph node dissection and intracorporeal esophagojejunostomy for proximal early gastric cancer.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

ABSTRACT
Single-incision laparoscopic total gastrectomy for gastric cancer has recently been reported by Seoul National University Bundang Hospital. However, this is not a popular procedure primarily because of the technical difficulties involved in achieving consistent intracorporeal esophagojejunostomy. At Seoul National University Bundang Hospital, we recently introduced a simple, easy-to-use, low-profile laparoscopic manual scope holder that enables the maintenance of a stable field of view, the most demanding condition in single-port gastrectomy. In this technical report, we describe in detail the world's first solo single-incision laparoscopic total gastrectomy with D1+ lymph node dissection and intracorporeal esophagojejunostomy for proximal early gastric cancer.

No MeSH data available.


Related in: MedlinePlus