Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
Ann Surg Oncol. 2018 Jan;25(1):246. doi: 10.1245/s10434-017-6066-1. Epub 2017 Oct 24.
Reduced port laparoscopic surgery (RPLS), as a more minimally invasive treatment alternative to conventional laparoscopic surgery (CLS), has been increasing in recent years. With the accumulation of surgical experience and improvements in surgical techniques, the indication of RPLS has been gradually extended from benign diseases to malignant tumors, including gastric cancer. However, due to the lack of counteraction and triangulation, lymphadenectomy during reduced port laparoscopic gastrectomy (RPLG) for gastric cancer was considered challenging. In this study, we report our experience performing RPLG with D2 lymphadenectomy for distal gastric cancer.
A disposable, single-incision, multiport, laparoscopic surgery trocar was used through a 3-cm incision at the umbilicus for the laparoscopist and surgeon's right hand. One 12-mm trocar was inserted at the upper-right quadrant for the surgeon's left hand. Distal gastrectomy with D2 lymphadenectomy was performed in the same manner with CLS. After extracting the resected specimen through the umbilicus incision, intracorporeal Roux-en-Y or B-II gastrojejunostomy was used for reconstruction.
RPLG with D2 lymphadenectomy was performed on five patients from April 2017 to June 2017. No intraoperative event requiring conversion to CLS or open surgery occurred. No postoperative complication was observed. The median operating time and blood loss was 166 min and 50 ml. The mean number of retrieved lymph nodes was 32.7. Postoperatively, the mean time to first flatus, soft intake, and hospital stay was 2.6, 3.5, and 6.7 days respectively.
RPLG with D2 lymphadenectomy might be safe and feasible in selected patients.
与传统腹腔镜手术（CLS）相比，减少端口腹腔镜手术（RPLS）作为一种更微创的治疗选择，近年来越来越受到关注。随着手术经验的积累和手术技术的提高，RPLS 的适应证已逐渐从良性疾病扩展到恶性肿瘤，包括胃癌。然而，由于缺乏对抗和三角测量，胃癌的 RPLG 淋巴结清扫术被认为具有挑战性。在本研究中，我们报告了我们使用一次性单切口多端口腹腔镜手术穿刺器在脐部 3cm 切口进行远端胃癌 RPLG 联合 D2 淋巴结清扫的经验。术者右手通过一个 3cm 的切口插入一个一次性单切口多端口腹腔镜手术穿刺器，术者左手通过右上象限插入一个 12mm 的穿刺器。D2 淋巴结清扫术与 CLS 相同。通过脐部切口取出切除标本后，采用经腔内置入 Roux-en-Y 或 B-II 胃肠吻合术进行重建。
2017 年 4 月至 6 月，我们对 5 例患者进行了 RPLG 联合 D2 淋巴结清扫术。无术中转为 CLS 或开放手术的事件发生。无术后并发症。手术时间和出血量的中位数分别为 166 分钟和 50ml。平均淋巴结清扫数目为 32.7 枚。术后首次排气、软食和住院时间的平均值分别为 2.6、3.5 和 6.7 天。
在选择的患者中，RPLG 联合 D2 淋巴结清扫术可能是安全可行的。
