Laparoscopic Total Gastrectomy with Transvaginal Specimen Extraction (GC-NOSES VIII)

Abstract

Laparoscopic total gastrectomy with transvaginal specimen extraction (GC-NOSES VIII) is mainly applicable to female patients with tumors located in the middle and upper stomach and gastroesophageal junction. As with conventional laparoscopic surgery for gastric cancer, principles of radical resection and digestive tract reconstruction should be strictly followed. Except that the method of specimen extraction is different from that of conventional laparoscopic surgery, the gastrointestinal tract resection, the extent of lymph node dissection, and dissection plane of surgery are consistent with those of conventional laparoscopic surgery. This is a resection extraction NOSES procedure. The operating characteristics are as follows: radical resection of gastric cancer and digestive tract reconstruction is performed under laparoscopy, and then an incision is made in the posterior vaginal fornix to extract specimen. Total laparoscopic radical resection and digestive tract reconstruction provides a broader view of operation field as to easily determine the direction of the bowel during reconstruction. In this way, common mistakes while operating with small auxiliary incision, such as bowel torsion and over-tension of the anastomosis, can be effectively avoid. Transvaginal specimen extraction avoids the auxiliary incision in the abdominal wall, preserves the function of the abdominal wall to the maximum, and reduces postoperative pain, which facilitates early ambulation and shortens recovery time, so as to minimize the physical and psychological effects of surgery.