Intracorporeal circular-stapled Billroth I anastomosis in single-incision laparoscopic distal gastrectomy
- 517 Downloads
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.
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.
We employed this technique in 20 patients. Neither postoperative complications, including anastomotic leakage and stricture, nor postoperative mortality were observed.
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.
KeywordsSingle-incision laparoscopic gastrectomy Billroth I reconstruction Gastroduodenostomy Intracorporeal anastomosis Gastric cancer Single port surgery
Drs. Takeshi Omori, Kouji Tanaka, Masayuki Tori, and Shigeyuki Ueshima have no conflicts of interest or financial ties to disclose. Dr. Toshirou Nishida has received a basic research grant funded by Novartis Pharmaceuticals Corporation.
- 11.Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc Percutan Tech 4:146–148Google Scholar
- 12.Pugliese R, Maggioni D, Sansonna F, Costanzi A, Ferrari GC, Di Lernia S, Magistro C, De Martini P, Pugliese F (2010) Subtotal gastrectomy with D2 dissection by minimally invasive surgery for distal adenocarcinoma of the stomach: results and 5-year survival. Surg Endosc 24:2594–2602PubMedCrossRefGoogle Scholar
- 15.Ichikawa D, Kubota T, Kikuchi S, Fujiwara H, Nakanishi M, Ikoma H, Okamoto K, Sakakura C, Ochiai T, Kokuba Y, Otsuji E (2009) Intracorporeal Billroth I anastomosis using a circular stapler by the abdominal wall lifting method in laparoscopy-assisted distal gastrectomy. Surg Laparosc Endosc Percutan Tech 19:e163–e166PubMedCrossRefGoogle Scholar