Okumura Yasuhiro, Narumiya Kousuke, Muraishi Ryo, Shimamoto Naoaki, Suda Hiroshi, Takemura Masashi, Yamashita Hiroharu, Okamura Yukiyasu
Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, 30-1, Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan.
Department of Surgery, Minami Osaka Hospital, 1-18-18, Higashi Kagaya, Suminoe-ku, Osaka, 559-0012, Japan.
Surg Today. 2025 Jul 1. doi: 10.1007/s00595-025-03094-y.
Minimally invasive esophagectomy (MIE) has been adopted widely, but achieving an adequate surgical view during laparoscopic gastric mobilization is difficult, which can prolong the operation time and increase intraoperative blood loss. We describe a new laparoscopic approach using 5 trocars, starting with mobilization of the gastric fundus. First, we dissect around the hiatus and mobilize the gastric fundus; then we divide the left gastric artery and vein, and mobilize the greater curvature. In our experience of performing this procedure in 10 patients, the median operative time and blood loss were 410 min and 200 mL, respectively, and the median duration of the procedure was 90 min. There were no cases of anastomotic leakage (AL) and only one case of anastomotic stricture, which was managed with endoscopic dilatation. Our novel laparoscopic approach for gastric mobilization demonstrates potential for safety and feasibility as a minimally invasive form of McKeown esophagectomy.
微创食管切除术（MIE）已被广泛采用，但在腹腔镜胃游离过程中获得足够的手术视野较为困难，这可能会延长手术时间并增加术中出血量。我们描述了一种使用5个套管针的新型腹腔镜手术方法，从胃底游离开始。首先，我们在食管裂孔周围进行解剖并游离胃底；然后我们切断胃左动脉和静脉，并游离胃大弯。根据我们对10例患者进行该手术的经验，中位手术时间和出血量分别为410分钟和200毫升，手术中位时长为90分钟。没有吻合口漏（AL）的病例，只有1例吻合口狭窄，通过内镜扩张进行了处理。我们新颖的腹腔镜胃游离方法显示出作为微创麦克基翁食管切除术的一种形式，具有安全和可行的潜力。
