Annals of Surgical Oncology

, Volume 24, Issue 6, pp 1658–1659 | Cite as

Three Trocars Laparoscopic Total Gastrectomy + D2 Lymphadenectomy with Intracorporeal Manual Esojejunostomy

  • Giovanni DapriEmail author
  • Maria Galdon Gomez
  • Guy-Bernard Cadière
  • Han-Kwang Yang
Gastrointestinal Oncology



Minimally invasive surgery (MIS) is proved to be feasible and safe oncologically. In the past decade, a new philosophy of MIS, reducing abdominal trauma and improving the cosmetic results, has been popularized. 1–3 The authors report a three trocars laparoscopic total gastrectomy + D2 lymphadenectomy for lesser curvature gastric adenocarcinoma.


A 52-year-old woman presenting a nondifferentiated gastric adenocarcinoma at the incisura angularis was admitted at consultation. Preoperative workup showed a T3N+M0 tumor. After neoadjuvant chemotherapy, laparoscopy was scheduled. Three trocars (5, 12, 5 mm) were placed in the abdomen. The operative field’s exposure was improved by temporary percutaneous sutures. En bloc total gastrectomy and omentectomy was performed with a D2 lymphadenectomy, including the nodes of the stations 1, 2, 3, 4, 5, 6, 7, 8a, 8p, 9, 10, 11p, 11d, and 12a. Completely manual end-to-side esophago-jejunal anastomosis (Fig. 1a, b) and linear mechanical side-to-side jejuno-jejunal anastomosis were realized with the closure of both mesenteric and mesocolic defects. The specimen was retrieved through a suprapubic access.


Operative time was 4 hours and 45 minutes (anastomosis: 30), and perioperative bleeding was 100 cc. Pathologic report confirmed nondifferentiated adenocarcinoma, mucinous, G3, infiltrating entirely the gastric wall, with 63 (4 positive) nodes removed; 7 edition UICC stage: pT4aN2aM0; keratine AE1/AE3 negative, HER2/neu, and HER2/CEP17 nonamplified. During postoperative follow-up, no recurrence was detected after 2 years.


Reduced port laparoscopic surgery provides the same quality of oncologic surgery as conventional multitrocar laparoscopy with added superior cosmesis and reduced abdominal trauma.



The other authors have no conflicts of interest or financial ties to disclosure regarding this video.

Supplementary material

Supplementary material 1 (MP4 80402 kb)


  1. 1.
    Dapri G. Himpens J, Cadière GB. Laparoscopic total gastrectomy and D2 lymphadenectomy. Ann Surg Oncol. 2010;17:1605.CrossRefGoogle Scholar
  2. 2.
    Inaki N. Reduced port laparoscopic gastrectomy: a review, techniques, and perspective. Asian J Endosc Surg. 2015;8:1–10.CrossRefPubMedGoogle Scholar
  3. 3.
    Kashiwagi H, Kumagai K, Monma E, Nozue M. Dual-port distal gastrectomy for the early gastric cancer. Surg Endosc. 2015;29;1321–6.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Giovanni Dapri
    • 1
    • 2
    Email author
  • Maria Galdon Gomez
    • 3
  • Guy-Bernard Cadière
    • 1
  • Han-Kwang Yang
    • 4
  1. 1.Department of Gastrointestinal Surgery, European School of Laparoscopic SurgerySaint-Pierre University Hospital, Université Libre de BruxellesBrusselsBelgium
  2. 2.Laboratory of AnatomyFaculty of Medicine and Pharmacy, University of MonsMonsBelgium
  3. 3.Department of PathologySaint-Pierre University Hospital and Jules Bordet Institut, Université Libre de BruxellesBrusselsBelgium
  4. 4.Department of Surgery and Cancer Research InstituteSeoul National University College of MedicineSeoulSouth Korea

Personalised recommendations