Total Gastrectomy

Abstract

Laparoscopic gastrectomy using five or six 5- or 10-mm ports is widely accepted as surgical treatment for early gastric cancer. The indications for laparoscopic gastrectomy have been expanded to include advanced cancer. Reduced port laparoscopic surgery (RPLS), such as single-port or needlescopic surgery is less invasive than conventional laparoscopic surgery and is considered quite beneficial in the field of endoscopic surgery. The concept of RPLS has been introduced to the surgical treatment of gastric cancer. An approximate 3.5-cm incision at the umbilicus is generally needed for specimen extraction. Therefore, the maximum scar in reduced port laparoscopic gastrectomy (RPLG) is the scar that results from this incision. RPLG, then, is actually performed as single-port laparoscopic gastrectomy (SPLG). The author uses inexpensive silicone access device as an umbilical platform to perform SPLG, maintaining the same quality lymphadenectomy and reconstruction that achieved with the multiport technique. SPLG ensures minimal injury to the abdominal wall and a good cosmetic outcome. In this chapter, our single-port laparoscopic total gastrectomy performed for gastric cancer is described in detail and illustrated with laparoscopic photos and a picture of the single platform viewed externally. The needle-assisted technique is also falls under the RPLS concept.