Technique

Surgical Endoscopy

, Volume 26, Issue 5, pp 1490-1494

Intracorporeal circular-stapled Billroth I anastomosis in single-incision laparoscopic distal gastrectomy

  • Takeshi OmoriAffiliated withDepartment of Surgery, Osaka Police Hospital Email author 
  • , Kouji TanakaAffiliated withDepartment of Surgery, Osaka Police Hospital
  • , Masayuki ToriAffiliated withDepartment of Surgery, Osaka Police Hospital
  • , Shigeyuki UeshimaAffiliated withDepartment of Surgery, Osaka Police Hospital
  • , Hiroki AkamatsuAffiliated withDepartment of Surgery, Osaka Police Hospital
  • , Toshirou NishidaAffiliated withDepartment of Surgery, Osaka Police Hospital

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Abstract

Purpose

The intracorporeal anastomotic procedure is one of the most difficult components in single-incision laparoscopic gastrectomy. We describe a simple surgical technique for intracorporeal circular-stapled Billroth I gastroduodenostomy with transumbilical introduction of the instrument.

Surgical technique

After standard laparoscopic mobilization of the distal stomach using a mini-loop retractor (diameter, 2 mm), a semi-circumference duodenotomy was made just distal to the pyloric ring. The anvil of a circular stapling device, secured with a Prolene suture with a needle, was introduced via the duodenotomy. The suture was advanced anteriorly such that an anvil shaft transfixed the anterior duodenal wall. The duodenum was staple-transected at this point, and the anvil shaft was removed from the duodenum by pulling the thread. The anvil shaft was advanced against the posterior wall of the stomach and tightly grasped by the mini-loop retractor to avoid slippage. After the cartridge-carrying instrument was introduced transumbilically with the pneumoperitoneum maintained using a surgical glove, the anvil shaft was connected with the center rod of the instrument under fine laparoscopic view. The instrument was fired to complete the circular-stapled gastroduodenostomy.

Results

We employed this technique in 20 patients. Neither postoperative complications, including anastomotic leakage and stricture, nor postoperative mortality were observed.

Conclusions

Our modified technique for intracorporeal Billroth I reconstruction in single-incision laparoscopic distal gastrectomy is safe and feasible. This technique could be an attractive surgical option for all laparoscopic reconstructive procedures using circular stapling devices.

Keywords

Single-incision laparoscopic gastrectomy Billroth I reconstruction Gastroduodenostomy Intracorporeal anastomosis Gastric cancer Single port surgery