Li Zeyu, Zhang Xiaolong, Tian Lifei, Liu Zheng, Liao Xinhua, Qiu Jian, Wang Guorong, Yan Likun, Wang Xiaoqiang, Wang Xishan, Liu Ruiting
Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China.
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Oncol. 2023 May 23;13:1189948. doi: 10.3389/fonc.2023.1189948. eCollection 2023.
Because of its significant advantage of fast postoperative recovery, natural orifice specimen extraction surgery (NOSES) has attracted increasing attention worldwide. However, the NOSES in gastric cancer (GC) treatment still needs more clinical practice, especially for the rare anatomical anomaly. Situs inversus totalis (SIT) is a rare autosomal recessive anatomical anomaly with an incidence ranging between 1/8,000 and 1/25,000 births. We present a video of transvaginal specimen extraction following totally laparoscopic D2 distal gastrectomy performed in a 59-year-old woman known to have SIT. Preoperative investigations revealed that the patient had early GC at the antrum. A gastroscopy report from the local hospital showed signet-ring cell carcinoma. The preoperative computed tomography scan revealed irregular thickening of the gastric wall at the junction of the greater curvature and antrum without metastasis to the lymph nodes. In total, laparoscopic D2 distal gastrectomy was performed with transvaginal specimen extraction. Billroth II with Braun anastomosis was performed for reconstruction. The length of the operation was 240 min without intraoperative complications and with minimal blood loss of 50 ml. The patient was uneventfully discharged on postoperative Day 7. The final pathology confirmed signet-ring cell carcinoma confined to the mucosal muscle without metastasis in 16 lymph nodes. Transvaginal specimen extraction following totally laparoscopic D2 distal gastrectomy can be safely performed in patients with SIT and has similar surgical outcomes to usual laparoscopic gastrectomy.
由于自然腔道标本取出手术（NOSES）具有术后恢复快的显著优势，在全球范围内受到了越来越多的关注。然而，NOSES在胃癌（GC）治疗中的应用仍需要更多的临床实践，特别是对于罕见的解剖变异情况。全内脏反位（SIT）是一种罕见的常染色体隐性解剖变异，发病率在每8000至25000例出生中约有1例。我们展示了一段视频，该视频记录了在一名已知患有SIT的59岁女性患者中进行全腹腔镜D2远端胃切除术后经阴道取出标本的过程。术前检查显示患者胃窦部患有早期GC。当地医院的胃镜报告显示为印戒细胞癌。术前计算机断层扫描显示胃大弯与胃窦交界处胃壁不规则增厚，无淋巴结转移。总共进行了全腹腔镜D2远端胃切除术并经阴道取出标本。采用毕Ⅱ式吻合加布朗吻合术进行重建。手术时长为240分钟，术中无并发症，失血极少，仅50毫升。患者术后第7天顺利出院。最终病理证实为印戒细胞癌，局限于黏膜肌层，16枚淋巴结无转移。全腹腔镜D2远端胃切除术后经阴道取出标本在SIT患者中可安全进行，且手术结果与常规腹腔镜胃切除术相似。
