Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, 543-0035, Japan.
Surg Endosc. 2011 Jul;25(7):2400-4. doi: 10.1007/s00464-010-1563-3. Epub 2011 Feb 7.
Laparoscopic gastrectomy is a widely accepted procedure for treating early gastric cancers. This procedure is less invasive than conventional open approaches, and the oncologic outcomes are comparable. Single-incision laparoscopic surgery, developed to reduce the invasiveness of traditional laparoscopy, is applied to various abdominal surgical procedures. However, its application to laparoscopic gastrectomy for the treatment of gastric cancer has not been reported, mainly because of difficulties achieving adequate lymphadenectomy and reconstruction. The authors report their initial clinical experience with single-incision laparoscopic gastrectomy for early gastric cancer.
A single vertical 2.5-cm intraumbilical incision was made, and three laparoscopic trocars were placed within the umbilicus. A 2-mm mini-loop retractor was inserted in the left upper and middle abdomen, and a roll of gauze was attached to its tip. This instrument is an atraumatic and useful tool for retracting various organs. Gastric mobilization and adequate dissection of lymph nodes were performed. The stomach and duodenum then were transected intracorporeally using linear staplers. Intracorporeal anastomosis was performed for reconstruction.
All seven single-incision laparoscopic distal gastrectomies with lymphadenectomy were performed without the use of additional trocars or conversion to laparotomy. The median time for gastric mobilization with lymphadenectomy was 155 min (range, 130-183 min). The median operative time was 344 min (range, 282-385 min), and the median estimated blood loss was 25 ml (range, 0-100 ml). A median total of 67 lymph nodes were retrieved. No serious perioperative complications occurred, and no mortalities were observed in this case series.
The authors' initial experience with single-incision laparoscopic distal gastrectomy showed that it is a feasible and safe procedure for early gastric cancer and gives a favorable cosmetic result. To the authors' knowledge, this is the first report describing successful single-incision laparoscopic gastrectomy for gastric cancer.
腹腔镜胃切除术是治疗早期胃癌的一种广泛接受的方法。与传统的开放性方法相比，这种方法具有较小的侵入性，并且肿瘤学结果相当。单切口腹腔镜手术旨在减少传统腹腔镜的侵入性，适用于各种腹部手术。然而，其在腹腔镜胃癌治疗中的应用尚未得到报道，主要是因为难以实现足够的淋巴结清扫和重建。作者报告了他们在早期胃癌的单切口腹腔镜胃切除术中的初步临床经验。
在脐部做一个 2.5 厘米的垂直单切口，在脐内放置三个腹腔镜套管。在左上腹部插入一个 2 毫米的迷你环牵开器，并将一卷纱布附在其尖端。这个器械是一种无创伤且有用的牵拉各种器官的工具。进行胃的游离和充分的淋巴结清扫。然后使用线性吻合器进行胃和十二指肠的腔内心内切断。进行腔内吻合以重建。
所有七例单切口腹腔镜远端胃切除术和淋巴结清扫术均无需使用额外的套管或转为剖腹手术。胃的游离和淋巴结清扫的中位时间为 155 分钟（范围，130-183 分钟）。手术时间的中位数为 344 分钟（范围，282-385 分钟），估计出血量的中位数为 25 毫升（范围，0-100 毫升）。共取出 67 个淋巴结。没有发生严重的围手术期并发症，也没有死亡病例。
作者的单切口腹腔镜远端胃切除术的初步经验表明，对于早期胃癌来说，这是一种可行且安全的手术，并且美容效果良好。据作者所知，这是首次报道成功的单切口腹腔镜胃癌手术。
