Skip to main content

Minimally Invasive Total Gastrectomy


The role of minimally invasive surgery for total gastrectomy is not well-established. This chapter describes the technical aspects of laparoscopic and robotic approaches for total gastrectomy for gastric cancer and discusses considerations regarding the learning curve and patient selection. The chapter also summarizes the current literature on minimally invasive approaches to total gastrectomy with focus on technique, outcomes, and cost.


  • Total gastrectomy
  • Robotic total gastrectomy
  • Gastric cancer
  • Minimally invasive total gastrectomy

This is a preview of subscription content, access via your institution.

Buying options

USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-1-4939-1893-5_8
  • Chapter length: 11 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
USD   99.00
Price excludes VAT (USA)
  • ISBN: 978-1-4939-1893-5
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   129.00
Price excludes VAT (USA)
Fig. 8.1
Fig. 8.2
Fig. 8.3
Fig. 8.4
Fig. 8.5
Fig. 8.6
Fig. 8.7
Fig. 8.8


  1. Hayashi H, Ochiai T, Shimada H, Gunji Y. Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc. 2005;19(9):1172–6. doi:10.1007/s00464-004-8207-4.

    CAS  PubMed  CrossRef  Google Scholar 

  2. Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg. 2005;241(2):232–7.

    PubMed Central  PubMed  CrossRef  Google Scholar 

  3. Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report–a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg. 2010;251(3):417–20. doi:10.1097/SLA.0b013e3181cc8f6b.

    PubMed  CrossRef  Google Scholar 

  4. Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008;248(5):721–7. doi:10.1097/SLA.0b013e318185e62e.

    PubMed  CrossRef  Google Scholar 

  5. Lee JH, Han HS, Lee JH. A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc. 2005;19(2):168–73. doi:10.1007/s00464-004-8808-y.

    PubMed  CrossRef  Google Scholar 

  6. Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y. A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery. 2002;131(1 Suppl):S306–11.

    PubMed  CrossRef  Google Scholar 

  7. Shim JH, Yoo HM, Oh SI, Nam MJ, Jeon HM, Park CH, et al. Various types of intracorporeal esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer. Gastric cancer. 2013;16(3):420–7. doi:10.1007/s10120-012-0207-9.

    PubMed  CrossRef  Google Scholar 

  8. Corcione F, Pirozzi F, Cuccurullo D, Angelini P, Cimmino V, Settembre A. Laparoscopic total gastrectomy in gastric cancer: our experience in 92 cases. Minim Invasive Ther Allied Technol. 2013;22(5):271–8. doi:10.3109/13645706.2012.743919.

    PubMed  CrossRef  Google Scholar 

  9. Liu XX, Jiang ZW, Chen P, Zhao Y, Pan HF, Li JS. Full robot-assisted gastrectomy with intracorporeal robot-sewn anastomosis produces satisfying outcomes. World J Gastroenterol. 2013;19(38):6427–37. doi:10.3748/wjg.v19.i38.6427.

    PubMed Central  PubMed  CrossRef  Google Scholar 

  10. Kelly KJ, Vivian ES. Robotic utilization in gastric cancer surgery. In: Hochwald S, editor. Minimally Invasive Foregut Surgery for Malignancy: Principles and Practice. New York: Springer; 2014.

    Google Scholar 

  11. Nagai E, Ohuchida K, Nakata K, Miyasaka Y, Maeyama R, Toma H, et al. Feasibility and safety of intracorporeal esophagojejunostomy after laparoscopic total gastrectomy: inverted T-shaped anastomosis using linear staplers. Surgery. 2013;153(5):732–8. doi:10.1016/j.surg.2012.10.012.

    PubMed  CrossRef  Google Scholar 

  12. Wang W, Zhang X, Shen C, Zhi X, Wang B, Xu Z. Laparoscopic versus open total gastrectomy for gastric cancer: an updated meta-analysis. PLoS One. 2014;9(2):e88753. doi:10.1371/journal.pone.0088753.

    PubMed Central  PubMed  CrossRef  Google Scholar 

  13. Marano A, Choi YY, Hyung WJ, Kim YM, Kim J, Noh SH. Robotic versus laparoscopic versus open gastrectomy: a meta-analysis. J Gastric cancer. 2013;13(3):136–48. doi:10.5230/jgc.2013.13.3.136.

    PubMed Central  PubMed  CrossRef  Google Scholar 

  14. Park JY, Jo MJ, Nam BH, Kim Y, Eom BW, Yoon HM, et al. Surgical stress after robot-assisted distal gastrectomy and its economic implications. Br J Surg. 2012;99(11):1554–61. doi:10.1002/bjs.8887.

    CAS  PubMed  CrossRef  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Vivian E. Strong M.D., F.A.C.S. .

Editor information

Editors and Affiliations

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

In this video, the surgeon demonstrates her approach to minimally invasive total gastrectomy for gastric carcinoma. (WMV 246,113 kb)

Key Operative Steps

Key Operative Steps

  1. 1.

    Explore abdomen for adhesions and peritoneal carcinomatosis. Ensure that 2–4 cm of adequate proximal margin can be obtained.

  2. 2.

    If the lesion cannot be appreciated on the extraluminal surface, perform intraoperative endoscopy.

  3. 3.

    Dock the robot.

  4. 4.

    Dissect the omentum from the colon in the avascular plane proceeding towards the splenic flexure and enter the lesser sac.

  5. 5.

    Grasp the posterior wall of the stomach and retract anteriorly and to the right. Ligate the short gastric vessels with energy sealant device up to the left crus.

  6. 6.

    Incise the peritoneum over the left crus and expose the posterolateral aspect of the esophagus.

  7. 7.

    Retract the stomach to the left side and proceed with omentectomy towards the hepatic flexure. Place fully mobilized omentum in the left upper quadrant.

  8. 8.

    Divide the posterior attachments between the stomach and the pancreas sharply or with an energy sealant device.

  9. 9.

    Dissect the right gastroepiploic vessels at the level of the superior border of the pancreas near the point of origin from the gastroduodenal vessels. The linear stapler can be used for this maneuver.

  10. 10.

    Incise the gastrohepatic attachments near the suprapyloric region. Identify and ligate the right gastric artery.

  11. 11.

    Dissect the lymphatic tissues along the proper hepatic and common hepatic artery towards the specimen creating a window at the level of the pylorus.

  12. 12.

    Mobilize the posterior aspect of the pylorus and proximal duodenum and divide the duodenum with a linear stapler. Use a bioabsorbable staple line reinforcement.

  13. 13.

    Continue dissecting lymphatic tissues toward the celiac axis and proximal splenic artery.

  14. 14.

    Identify and ligate the left gastric vein and artery. Dissect all lymphatic tissues with the specimen.

  15. 15.

    Further incise gastrohepatic attachments to the level of the esophageal hiatus. Level 1 and 3 lymph nodes are dissected with the proximal stomach up to the right crus and esophagus.

  16. 16.

    Mobilize distal esophagus and divide it with a linear stapler.

  17. 17.

    Place specimen in a specimen bag and remove via the umbilical port site.

  18. 18.

    A Roux limb is prepared 30–40 cm downstream from the ligament of Treitz. Transect jejunum with a linear stapler.

  19. 19.

    Create jejunojejunostomy 60–70 cm downstream from the transected jejunum.

  20. 20.

    Perform esophagojejunostomy with a transoral anvil device and a circular stapler.

Rights and permissions

Reprints and Permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Kelly, K.J., Strong, V.E. (2015). Minimally Invasive Total Gastrectomy. In: Kim, J., Garcia-Aguilar, J. (eds) Surgery for Cancers of the Gastrointestinal Tract. Springer, New York, NY.

Download citation

  • DOI:

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1892-8

  • Online ISBN: 978-1-4939-1893-5

  • eBook Packages: MedicineMedicine (R0)