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The Hepatic Left Lateral Segment Inverting Method Offering a Wider Operative Field of View During Laparoscopic Proximal Gastrectomy

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

In laparoscopic proximal gastrectomy, the hepatic left lateral segment often obstructs the operative field of view, especially around the esophageal hiatus. Therefore, a safe retraction method is needed. The present study aimed to determine the effectiveness of inverting the hepatic left lateral segment in laparoscopic proximal gastrectomy.

Methods

This was a retrospective review of 81 consecutive patients who underwent laparoscopic proximal gastrectomy. Patients were divided into two groups, i.e., the Nathanson liver retractor group (n = 41) and hepatic left lateral segment inverting group (n = 40). The unedited video recordings of the procedures and the patients’ medical records were reviewed and compared.

Results

The hepatic left lateral segment inverting method provided a more satisfactory view of the operative fields and a wider working space around the esophageal hiatus than the Nathanson liver retractor. No intraoperative hepatic congestion and significantly improved postoperative liver enzyme elevations were observed with hepatic left lateral segment inverting method compared with the Nathanson liver retractor method.

Conclusions

In laparoscopic proximal gastrectomy, the hepatic left lateral segment inverting method appears to provide improvements in both the operative field of view and liver protection compared with the Nathanson liver retractor method.

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References

  1. Yamashita H, Seto Y, Sano T, Makuuchi H, Ando N, Sasako M. Results of a nation-wide retrospective study of lymphadenectomy for esophagogastric junction carcinoma. Gastric Cancer 2017;20:69-83.

    Article  CAS  Google Scholar 

  2. Kinjo Y, Okabe H, Obama K, Tsunoda S, Tanaka E, Sakai Y. Elevation of liver function tests after laparoscopic gastrectomy using a Nathanson liver retractor. World J Surg 2011;35:2730-2738.

    Article  Google Scholar 

  3. Nakauchi M, Suda K, Susumu S, Kadoya S, Inaba K, Ishida Y, Uyama I. Comparison of the long-term outcomes of robotic radical gastrectomy for gastric cancer and conventional laparoscopic approach: a single institutional retrospective cohort study. Surg Endosc 2016;30:5444-5452.

    Article  Google Scholar 

  4. Japanese Gastric Cancer Association. Gastric Cancer Treatment Guidelines 2018. The 5th Edition. Tokyo: KANEHARA & CO., LTD., 2018.

  5. Suda K, Man IM, Ishida Y, Kawamura Y, Satoh S, Uyama I. Potential advantages of robotic radical gastrectomy for gastric adenocarcinoma in comparison with conventional laparoscopic approach: a single institutional retrospective comparative cohort study. Surg Endosc 2015;29:673-685.

    Article  Google Scholar 

  6. Nakamura K, Suda K, Suzuki A, Nakauchi M, Shibasaki S, Kikuchi K, Nakamura T, Kadoya S, Inaba K, Uyama I. Intracorporeal isosceles right triangle-shaped anastomosis in totally laparoscopic distal gastrectomy. Surg Laparosc Endosc Percutan Tech 2018;28:193-201.

    PubMed  Google Scholar 

  7. Shinohara T, Satoh S, Kanaya S, Ishida Y, Taniguchi K, Isogaki J, Inaba K, Yanaga K, Uyama I. Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: a retrospective cohort study. Surg Endosc 2013;27:286-294.

    Article  Google Scholar 

  8. Shibasaki S, Suda K, Nakauchi M, Kikuchi K, Kadoya S, Ishida Y, Inaba K, Uyama I. Robotic valvuloplastic esophagogastrostomy using double flap technique following proximal gastrectomy: technical aspects and short-term outcomes. Surg Endosc 2017;31:4283-4297.

    Article  Google Scholar 

  9. Tanaka T, Suda K, Inaba K, Umeki Y, Gotoh A, Ishida Y, Uyama I. Impact of frailty on postoperative outcomes for laparoscopic gastrectomy in patients older than 80 years. Ann Surg Oncol 2019;26: 4016-4026.

    Article  Google Scholar 

  10. Nomura E, Lee SW, Kawai M, Yamazaki M, Nabeshima K, Nakamura K, Uchiyama K. Functional outcomes by reconstruction technique following laparoscopic proximal gastrectomy for gastric cancer: double tract versus jejunal interposition. World J Surg Oncol 2014;12:20.

    Article  Google Scholar 

  11. Okabe H, Obama K, Tanaka E, Tsunoda S, Akagami M, Sakai Y. Laparoscopic proximal gastrectomy with a hand-sewn esophago-gastric anastomosis using a knifeless endoscopic linear stapler. Gastric cancer 2013;16:268-274.

    Article  Google Scholar 

  12. Mori T, Kimura T, Kitajima M. Skill accreditation system for laparoscopic gastroenterologic surgeons in Japan. Minim Invasive Ther Allied Technol 2010;19:18-23.

    Article  Google Scholar 

  13. Japanese Gastric Cancer Association. Japanese Classification of Gastric Carcinoma. The 15th Edition. Tokyo: KANEHARA & CO., LTD., 2017.

  14. World Health Organization. Obesity: Preventing and managing the global epidemic. Report of a WHO Consultation. World Health Organ Tech Rep Ser 2000;894:i-xii, 1-253.

  15. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213.

    Article  Google Scholar 

  16. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250:187-196.

    Article  Google Scholar 

  17. Katai H, Mizusawa J, Katayama H, Kunisaki C, Sakuramoto S, Inaki N, Kinoshita T, Iwasaki Y, Misawa K, Takiguchi N, Kaji M, Okitsu H, Yoshikawa T, Terashima M. Single-arm confirmatory trial of laparoscopy-assisted total or proximal gastrectomy with nodal dissection for clinical stage I gastric cancer: Japan Clinical Oncology Group study JCOG1401. Gastric Cancer 2019; 22:999-1008.

    Article  CAS  Google Scholar 

  18. Morris-Stiff G, Jones R, Mitchell S, Barton K, Hassn A. Retraction transaminitis: an inevitable but benign complication of laparoscopic fundoplication. World J Surg 2008;32:2650-2654.

    Article  Google Scholar 

  19. Shinohara T, Kanaya S, Yoshimura F, Hiramatsu Y, Haruta S, Kawamura Y, Giacopuzzi S, Fujita T, Uyama I. A protective technique for retraction of the liver during laparoscopic gastrectomy for gastric adenocarcinoma: using a Penrose drain. J Gastrointest Surg 2011;15:1043-1048.

    Article  Google Scholar 

  20. Saeki H, Oki E, Kawano H, Ando K, Ida S, Kimura Y, Morita M, Kusumoto T, Ikeda T, Maehara Y. Newly developed liver-retraction method for laparoscopic gastric surgery using a silicone disc: the phi-shaped technique. J Am Coll Surg 2013;216:e43-46.

    Article  Google Scholar 

  21. Sakaguchi Y, Ikeda O, Toh Y, Aoki Y, Harimoto N, Taomoto J, Masuda T, Ohga T, Adachi E, Okamura T. New technique for the retraction of the liver in laparoscopic gastrectomy. Surg Endosc 2008;22:2532-2534.

    Article  Google Scholar 

  22. Lee SH, Kim KH, Choi CW, Kim SJ, Kim DH, Choi CI, Jeon TY, Kim DH, Hwang SH. Atraumatic liver retraction using nelaton catheters during totally laparoscopic gastrectomy. Surg Laparosc Endosc Percutan Tech 2017;27:485-490.

    Article  Google Scholar 

  23. Shibao K, Higure A, Yamaguchi K. Disk suspension method: a novel and safe technique for the retraction of the liver during laparoscopic surgery (with video). Surg Endosc 2011;25:2733-2737.

    Article  Google Scholar 

  24. Yoshikawa K, Shimada M, Higashijima J, Nakao T, Nishi M, Takasu C, Kashihara H, Eto S. Combined liver mobilization and retraction: a novel technique to obtain the optimal surgical field during laparoscopic total gastrectomy. Asian J Endosc Surg 2016;9:111-115.

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Acknowledgments

The authors are indebted to the Maruzen Co., Ltd. (Tokyo, Japan) for their review of the present manuscript as native English speakers.

Funding

This work was not supported by any grants or funding. Ichiro Uyama has received lecture fees from Intuitive Surgical, Inc. Koichi Suda and Kenji Kikuchi have been funded by Medicaroid, Inc. in relation to Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University. Koichi Suda has also received advisory fees from Medicaroid, Inc. outside of the submitted work.

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Authors and Affiliations

  1. Department of Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan

    Kenichi Nakamura MD, PhD, Koichi Suda MD, PhD, FACS, Susumu Shibasaki MD, PhD, FACS, Masaya Nakauchi MD, PhD, FACS, Kenji Kikuchi MD, PhD, Kazuki Inaba MD, PhD, FACS & Ichiro Uyama MD, PhD, FACS

Authors
  1. Kenichi Nakamura MD, PhD
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  2. Koichi Suda MD, PhD, FACS
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  3. Susumu Shibasaki MD, PhD, FACS
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  4. Masaya Nakauchi MD, PhD, FACS
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  5. Kenji Kikuchi MD, PhD
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  6. Kazuki Inaba MD, PhD, FACS
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  7. Ichiro Uyama MD, PhD, FACS
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Contributions

All the authors have fully met the ICMJE authorship criteria as follows: (1) Study design: Kenichi Nakamura, Koichi Suda; Data collection: Kenichi Nakamura; Statistical analysis and interpretation of results: Kenichi Nakamura, Koichi Suda, Susumu Shibasaki, Masaya Nakauchi, Kenji Kikuchi, Kazuki Inaba, Ichiro Uyama; (2) Drafting of the manuscript: Kenichi Nakamura, Koichi Suda; Critical revision of the manuscript for important intellectual content: Koichi Suda, Susumu Shibasaki, Masaya Nakauchi, Kenji Kikuchi, Kazuki Inaba, Ichiro Uyama. All authors read and approved the final manuscript. All authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Koichi Suda MD, PhD, FACS.

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Conflict of Interest

Kenichi Nakamura, Koichi Suda, Susumu Shibasaki, Masaya Nakauchi, Kenji Kikuchi, and Kazuki Inaba have no commercial association with or financial involvement that might pose a conflict of interest in connection with the submitted article.

Ethical Standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or a substitute for it was obtained from all patients before being included in the study.

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Nakamura, K., Suda, K., Shibasaki, S. et al. The Hepatic Left Lateral Segment Inverting Method Offering a Wider Operative Field of View During Laparoscopic Proximal Gastrectomy. J Gastrointest Surg 24, 2395–2403 (2020). https://doi.org/10.1007/s11605-020-04655-x

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  • DOI: https://doi.org/10.1007/s11605-020-04655-x

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