Gastrointestinal Surgery

Abstract

Since the introduction of laparoscopy in 1910, Nezhat et al. (J Reprod Med 34:127–134, 1989) the benefits of minimally invasive surgery have expanded its applicability to the treatment of benign and malignant gastric diseases (Liew et al., ANZ J Surg 77:787–791, 2007). But since the first publication about single incision laparoscopic sleeve gastrectomy reported by Saber (Obes Surg 18:1338–1342, 2008), only a few sporadic reports about single incision laparoscopic gastric surgery have appeared worldwide. These articles were always involved with laparoscopic sleeve gastrectomy in obese patients (Morales-Conde et al., Surg Innov [Epub ahead of print], 2011; Lakdawala et al., Obes Surg 21:1664–1670, 2011; Vilallonga et al., J Minim Access Surg 7:156–157, 2011). And in their opinion, this novel approach is feasible, but not always easily reproducible.

The first reported SILS partial resection of the stomach for the treatment of GIST was by Yasumitsu Hirano et al. in 2010 (Hirano et al., Surg Laparosc Endosc Percutan Tech 20:262–264, 2010). Then a few studies about SILS partial resection of the stomach or gastric wedge resection were reported (Na et al., J Gastric Cancer 11:225–229, 2011; Wu et al., Surg Innov [Epub ahead of print], 2012; Henckens et al., J Laparoendosc Adv Surg Tech A 20:469–471, 2010; Dapri et al., Ann Surg Oncol 18:191, 2011; Sasaki et al., Surg Today 41:133–136, 2011; Nonaka et al., Surg Laparosc Endosc Percutan Tech 22:e210–e213, 2012). In jin-UK’s report, Na et al. (J Gastric Cancer 11:225–229, 2011) seven patients diagnosed with gastric submucosal tumor underwent the intragastric wedge resection. Though flexible laparoscope and curved or double-bended graspers were used frequently and made the SILS operation easier, conventional laparoscopic instruments can achieve the similar clinical outcomes (Wu et al., Surg Innov [Epub ahead of print], 2012). Also an extra mini-port for 2 mm Mini-loop was often used to retract the liver or gastric wall surrounding the tumor to facilitate the dissection and resection (Henckens et al., J Laparoendosc Adv Surg Tech A 20:469–471, 2010; Dapri et al., Ann Surg Oncol 18:191, 2011; Sasaki et al., Surg Today 41:133–136, 2011). Except wounding bleeding in one case, Na et al. (J Gastric Cancer 11:225–229, 2011) no intraoperative or other postoperative complications were experienced in all the patients including anastomotic leakage, bleeding or anastomotic stenosis.

A patient with an intractable gastric ulcer was treated by SILS gastrectomy with intracorporeal Roux-en-Y reconstruction in 2012 (Nonaka et al., Surg Laparosc Endosc Percutan Tech 22:e210–e213, 2012). The operative time was 412 min, with blood loss 90 ml. Also in 2012, another case about SILS perforated gastric ulcer repair was reported (Dapri et al., Surg Innov 19:130–133, 2012). The operation lasted 108 min. The blood loss was 86 ml.

Ten patients underwent single-incision laparoscopic distal gastrectomy and lymph node D1α or D1β dissection in three reports (Omori et al., Surg Endosc 25:2400–2404, 2011; Park et al., Surg Laparosc Endosc Percutan Tech 22:e214–e216, 2012; Ozdemir et al., Surg Innov 18:NP1–NP4, 2011). The final pathology report showed that the tumor had invaded the submucosa or proper muscle with no seromuscular layer infiltration. A total of 172 lymph nodes were retrieved. Except one patient with 5 metastases among dissected 21 lymph nodes, Takahashi et al. (Am Surg 78:447–450, 2012) lymph nodes of other patients were identified with no tumor metastasis. In Lee JH’s [19] report, the porcine model was used to compare the perioperative outcomes of SILS and conventional laparoscopic distal gastrectomy with D1 + b lymph node dissection. The single-incision laparoscopic group was associated with a significantly longer operation time, but it had a similar mean number of resected lymph nodes and with similar inflammatory reaction and complication rates when compared with conventional laparoscopic.