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Laparoscopic Distal/Subtotal Gastrectomy

Abstract

Gastric cancer remains a leading cause of cancer-related deaths worldwide. Historically, curative surgical intervention was open gastrectomy but recent studies suggest that laparoscopic gastrectomy may be equivalent to or better than open gastrectomy. Although a laparoscopic approach may not be ideal for all patients, the procedure may result in less blood loss, shorter recovery time, and similar survival rates compared to open gastrectomy. One of the critical components of laparoscopic gastric surgery is lymph node dissection because of its technical complexity. This chapter outlines the step-by-step surgical procedure to perform laparoscopic gastrectomy and lymph node dissection. The chapter highlights key techniques, discusses anatomic considerations, and describes proper care for a successful laparoscopic gastrectomy.

Keywords

  • Gastric cancer
  • Laparoscopic gastrectomy
  • Distal gastrectomy
  • D2 lymph node dissection

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Correspondence to Joseph Kim M.D., F.A.C.S. .

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In this video, the surgeon demonstrates his approach to laparoscopic distal subtotal gastrectomy. (WMV 100154 kb)

Key Operative Steps

  1. 1.

    Gastrectomy and lymphadenectomy are performed in a clockwise set of maneuvers.

  2. 2.

    Divide the gastrocolic ligament in the avascular plane, enter the lesser sac, and expose the anterior surface of the pancreas.

  3. 3.

    Perform intraoperative EGD to confirm the location of the tumor and mark the line of gastric transection.

  4. 4.

    Ligate the right gastroepiploic vessels and harvest nodal tissues (station 6).

  5. 5.

    Divide the duodenum and identify the gastroduodenal artery.

  6. 6.

    Identify and ligate the right gastric artery (station 5).

  7. 7.

    Harvest nodal tissues at station 1.

  8. 8.

    Harvest lymphatic tissues along the proximal proper hepatic artery (station 12) and common hepatic artery (station 8). Along the superior border of the pancreas, expose the celiac axis (station 9), the splenic artery (station 11), and then the left gastric artery (station 7).

  9. 9.

    Ligate the coronary vein to the right of the left gastric artery.

  10. 10.

    Ligate the left gastric artery.

  11. 11.

    Transect the stomach with a linear stapler with thick tissue cartridges.

  12. 12.

    Reconstruct with Billroth II gastrojejunostomy.

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Hamner, J.B., Kim, J. (2015). Laparoscopic Distal/Subtotal Gastrectomy. In: Kim, J., Garcia-Aguilar, J. (eds) Surgery for Cancers of the Gastrointestinal Tract. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1893-5_7

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  • DOI: https://doi.org/10.1007/978-1-4939-1893-5_7

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