Abstract
Background
Laparoscopy-assisted total gastrectomy (LATG) is not a commonly performed procedure due to the surgical difficulty associated with reconstruction. Although various reconstruction methods have been reported, a standard technique has not yet been established. In this study, we compared the short-term outcomes of LATG reconstructed by mini-laparotomy and by the newly developed transorally inserted anvil (OrVil™).
Methods
From April 2006, a series of 45 patients underwent LATG. Of these, 15 were reconstructed by mini-laparotomy and 30 by OrVil™. Short-term outcomes were compared between the two groups.
Results
Operation time was significantly shortened and intraoperative blood loss significantly reduced by the use of OrVil™. The postoperative course, including morbidity, did not differ between the two groups.
Conclusions
LATG using OrVil™ for the treatment of early gastric cancer is a technically feasible surgical procedure with sufficient lymph node dissection, satisfactory early recovery, and acceptable morbidity. It will be necessary to perform this novel technique in a large number of patients to confirm its feasibility.
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References
Kitano S, Shimoda K, Miyahara M, Shiraishi N, Bandoh T, Yoshida T, Shuto K, Kobayashi M (1995) Laparoscopic approaches in the management of patients with early gastric carcinomas. Surg Laparosc Endosc 5:359–362
Hayashi H, Ochiai T, Shimada H, Gunji Y (2005) Prospective randomized study of open vs laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc 19:1172–1176
Tanimura S, Higashino M, Fukunaga Y, Kishida S, Nishikawa M, Ogata A, Osugi H (2005) Laparoscopic distal gastrectomy with regional lymph node dissection for gastric cancer. Surg Endosc 19:1177–1181
Tan YK, Fielding JW (2006) Early diagnosis of early gastric cancer. Eur J Gastroenterol Hepatol 18:821–829
Lee JH, Han HS, Lee JH (2005) A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer. Surg Endosc 19:168–173
Kawamura H, Okada K, Isizu H, Masuko H, Yamagami H, Honma S, Ueki S, Noguchi K, Kondo Y (2008) Laparoscopic gastrectomy for early gastric cancer targeting as a less invasive procedure. Surg Endosc 22:81–85
Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N, Japanese Laparoscopic Surgery Study Group (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245:68–72
Usui S, Ito K, Hiranuma S, Takiguchi N, Matsumoto A, Iwai T (2007) Hand-assisted laparoscopic esophagojejunostomy using newly developed purse-string suture instrument “Endo-PSI”. Surg Laparosc Endosc Percutan Tech 17:107–110
Uyama I, Sugioka A, Matsui H, Fujita J, Komori Y, Hatakawa Y, Hasumi A (2001) Laparoscopic side-to-side esophagogastrostomy using a linear stapler after proximal gastrectomy. Gastric Cancer 4:98–102
Jeong O, Park YK (2009) Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil™) after laparoscopic total gastrectomy. Surg Endosc. doi: 10.1007/s00464-009-0461-z, April 3 2009
Japanese Gastric Cancer Association (1998) Japanese Classification of Gastric Carcinoma—2nd English edition. Gastric Cancer 1:10–24
Sakuramoto S, Kikuchi S, Futawatari N, Katada N, Moriya H, Hirai K, Yamashita K, Watanabe M (2009) Laparoscopy-assisted pancreas- and spleen-preserving total gastrectomy for gastric cancer as compared with open total gastrectomy. Surg Endosc. doi:10.1007/s00464-009-0371-0, 6 March 2009
Okabe H, Satoh S, Inoue H, Kondo M, Kawamura J, Nomura A, Nagayama S, Hasegawa S, Itami A, Watanabe G, Sakai Y (2007) Esophagojejunostomy through minilaparotomy after laparoscopic total gastrectomy. Gastric Cancer 10:176–180
Mochiki E, Toyomasu Y, Ogata K, Andoh H, Ohno T, Aihara R, Asao T, Kuwano H (2008) Laparoscopically assisted total gastrectomy with lymph node dissection for upper and middle gastric cancer. Surg Endosc 22:1997–2002
Pugliese R, Maggioni D, Sansonna F, Scandroglio I, Ferrari GC, Di Lernia S, Costanzi A, Pauna J, de Martini P (2007) Total and subtotal laparoscopic gastrectomy for adenocarcinoma. Surg Endosc 21:21–27
Tanimura S, Higashino M, Fukunaga Y, Kishida S, Ogata A, Fujiwara Y, Osugi H (2007) Laparoscopic gastrectomy with regional lymph node dissection for upper gastric cancer. Br J Surg 94:204–207
Chavarriaga LF, Cook MW, White B, Jeansonne L, Gletsu N, Parker CB, Sweeney J, Davis SS, Lin E (2010) Transoral technique for gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass (LRYGBP) can accelerate learning curve and reduce cost. Obes Surg 20:846–850
Disclosures
Drs. Kunisaki, Makino, Oshima, Fujii, Kimura, Takagawa, Kosaka, Akiyama, and Endo have no conflicts of interest or financial ties to disclose.
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Kunisaki, C., Makino, H., Oshima, T. et al. Application of the transorally inserted anvil (OrVil™) after laparoscopy-assisted total gastrectomy. Surg Endosc 25, 1300–1305 (2011). https://doi.org/10.1007/s00464-010-1367-5
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DOI: https://doi.org/10.1007/s00464-010-1367-5