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Minimally Invasive Gastrectomy Step by Step: How I Do It

  • Antonio Talvane Torres de Oliveira
  • Croider Franco Lacerda
  • Paulo A. Bertulucci
  • Miguel A. CuestaEmail author
Chapter
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Abstract

  1. 1.

    Positioning of patient and placement of trocars (Fig. 19.1) (Video 19.1)

     
  2. 2.

    Dissection of greater omentum from transverse colon from the middle to the left. Division of the short vessels up to the right crus of the hiatus (Figs. 19.2, 19.3, 19.4, and 19.5).

     
  3. 3.

    Dissection of the greater omentum to the right up to hepatic flexure

     
  4. 4.

    Dissection of the right gastroepiploic vessels, lymphadenectomy (group 6) and division of the vessels at the level of the pancreas (Figs. 19.6, 19.7, and 19.8)

     
  5. 5.

    Opening of the hepatoduodenal ligament (in the length). Lymphadenectomy of the common hepatic artery, and lymphadenectomy and division of the right gastric artery (groups 8a and 12a) (Figs. 19.9, 19.10, 19.11, 19.12, and 19.13)

     
  6. 6.

    Dissection of proximal duodenum and division by stapler (Figs. 19.14 and 19.15)

     
  7. 7.

    Retraction of the stomach to the left.

     
  8. 8.

    Continuing the lymphadenectomy of the celiac trunk, left gastric vein and artery and along the splenic artery (groups 9, 7 and 11p). Division of the left gastric vein and artery (Figs. 19.16, 19.17, and 19.18)

     
  9. 9.

    Continuing the dissection from here to the hiatus where the esophagus is dissected free and divided at the proper level by stapler and prepared for any type of anastomosis (Figs. 19.19, 19.20, 19.21, and 19.22)

     
  10. 10.

    Lymphadenectomy of groups 11d and 10 (Figs. 19.23 and 19.24)

     
  11. 11.

    Operative field before reconstruction (Figs. 19.25, 19.26, and 19.27)

     
  12. 12.

    Opening a hole in the mesocolon. Dividing the proximal jejunum by stapler and distal part through the mesocolon

     
  13. 13.

    Opening de jejunum stump and introducing the circular stapler 25 mm

     
  14. 14.

    End-to-side esophago-jejunostomy (Figs. 19.28, 19.29, 19.30, and 19.31)

     
  15. 15.

    Side-to-side jejuno-jejunostomy by stapler and closure of the opening (Figs. 19.32, 19.33, and 19.34)

     
  16. 16.

    Final situation after reconstruction (Fig. 19.35)

     
  17. 17.

    Retrieval of the specimen

     
  18. 18.

    Placing of drains

     

Supplementary material

Video 19.1

Laparoscopic total gastrectomy (WMV 32636 kb)

Video 19.2

Laparoscopic subtotal gastrectomy (WMV 37222 kb)

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Antonio Talvane Torres de Oliveira
    • 1
  • Croider Franco Lacerda
    • 1
  • Paulo A. Bertulucci
    • 1
  • Miguel A. Cuesta
    • 2
    Email author
  1. 1.Department of Upper GI SurgeryAmericas Medical City HospitalRio de JaneiroBrazil
  2. 2.VUmcAmsterdamThe Netherlands

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