V-shaped lymph node dissection in laparoscopic distal gastrectomy; new technique of intra-abdominal dissection and surgi
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WORLD JOURNAL OF SURGICAL ONCOLOGY
TECHNICAL INNOVATIONS
Open Access
V-shaped lymph node dissection in laparoscopic distal gastrectomy; new technique of intra-abdominal dissection and surgical outcomes Nobuhisa Matsuhashi1,2,3*, Narutoshi Nagao1, Yoshinori Iwata1, Sang-Woong Lee2, Takaya Tokuhara2, Chihiro Tanaka1, Masahiko Kawai1, Katsuyuki Kunieda1 and Kazuhiro Yoshida3
Abstract Background: Recently, laparoscopic-assisted distal gastrectomy (LADG) has become popular for the treatment of early gastric cancer. Furthermore, the use of totally laparoscopic gastrectomy (TLG), a more difficult procedure than LADG, has been increasing in Japan. Laparoscopic-assisted distal gastrectomy is currently performed more frequently than laparoscopic distal gastrectomy (LDG) in hospitals in Japan. Method: Reconstruction after LDG is commonly performed extra-abdominally and lymph node dissection of the lesser curvature is performed at the same time. We have developed a new method of intra-abdominal lymph node dissection for the lesser curvature. Results: Our technique showed positive results, is easy to perform, and is reasonable in terms of general oncology theory. Conclusion: In oncological therapy, this technique could be a valuable surgical option for totally laparoscopic surgery. Keywords: Laparoscopic gastrectomy, Lymph node dissection
Background We have developed a new method of intra-abdominal lymph node dissection for the lesser curvature, called Vshaped dissection. In this report, we present the outcome of our initial experience with this procedure.
Patients
Fourteen patients with early gastric cancer patients who underwent totally laparoscopic gastrectomy (TLG) using our new method reported lesser curvature lymph node dissection from April 2011 to November 2011 at Gifu
* Correspondence: [email protected] 1 Department of Surgery, Gifu Prefectural General Medical Center, 1-1 Yanagido, Gifu City, Japan 2 Department of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan Full list of author information is available at the end of the article
Prefectural General Medical Center, Japan. During the same period, 31 patients who underwent conventional distal gastrectomy (CDG) reported advanced gastric cancer combined with pathological lymph nodes in the lesser curvature.
Method At our Unit for Laparoscopic Gastrectomy, we are able to check for and confirm gastric cancer up to stages T1a(M), T1b(SM), N0, IA in preoperative diagnosis [1]. We are also able to check for distal gastrectomy indicated by distal and middle third gastric cancers in which tumor margins of at least 2 to 3 cm for early lesion can be taken. However, proximal gastrectomy and total gastrectomy in total laparoscopic surgery are currently not included in our skill set at the unit. Lymph node dissection is performed depending on the endoscopic depth of invasion of the primary tumor and
© 2012 Matsuhashi et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Att
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