Gasless laparoscopy-assisted distal gastrectomy is feasible and useful for non-obese patients with early gastric cancer.

BACKGROUND/AIMS: To evaluate the feasibility and usefulness of gasless laparoscopy-assisted distal gastrectomy except when treating obese patients compared with open distal gastrectomy for early cancer. METHODOLOGY: We treated 92 patients with distal gastrectomy for early gastric cancer consecutively. Patients with massive submucosal invasion and/or LN swelling were allocated for the open method, and patients with slightly invasive submucosal cancer were allocated for gasless laparoscopy-assisted surgery. As exceptions we employed open surgery for overweight patients and gasless laparoscopy for elderly and/or feeble patients. RESULTS: We attempted to perform open and laparoscopy-assisted surgery on 52 and 40 patients, respectively. Three cases in the laparoscopy-assisted group were converted to open surgery because of obesity. The age was older and BMI was lower in the laparoscopy-assisted group. In terms of operative time and blood loss as well as postoperative recovery, the results for the laparoscopy-assisted group were superior to those of the open surgery group. There were no cases of cardiopulmonary complications for the laparoscopy-assisted group. CONCLUSIONS: Gasless laparoscopy-assisted distal gastrectomy is feasible and useful for early gastric cancer except when treating obese patients.

Gasless laparoscopy-assisted colon surgery utilizing mini-laparotomy and a subcutaneous abdominal wall lift system.

BACKGROUND/AIMS: This study was performed to investigate the technical aspects and perioperative results of using a subcutaneous abdominal wall lift system for laparoscopy-assisted colectomy. METHODOLOGY: We attempted a laparoscopy-assisted colectomy for 19 patients and completed 16 cases using mini-laparotomy and a subcutaneous abdominal wall lift system, observing monitor images via laparoscopy or direct views through mini-laparotomy. All 5 surgeons had no experience of laparoscopy-assisted colectomy but considerable experience of laparoscopic cholecystectomy. RESULTS: The operating time ranged from 120 to 360 minutes with an average of 188. Intraoperative blood loss ranged from 20 to 300 mL with an average of 116 mL. No postoperative major complications occurred, but 5 cases suffered wound infection. CONCLUSIONS: Laparoscopy-assisted colon surgery utilizing a subcutaneous abdominal wall system and mini-laparotomy was feasible as minimally invasive surgery for colorectal diseases, even for surgeons with little previous experience.

Gasless laparoscopy-assisted distal gastrectomy for early cancer via mini-laparotomy using an abdominal wall lift.

BACKGROUND/AIMS: To investigate the technical ease and results of gasless laparoscopy-assisted distal gastrectomy with lymph node dissection via mini-laparotomy using abdominal wall lift for early gastric cancer. METHODOLOGY: We submitted 20 patients to laparoscopy-assisted distal gastrectomy for early gastric cancer located in the middle or lower stomach. The initial 10 cases underwent perigastric lymph node dissection (D1), and the subsequent 10 cases received further dissection around the left gastric and common hepatic arteries (D1 + a). Mini-laparotomy was placed at the beginning of the procedure. We lifted up the laparotomy and the subcutaneous tissue around the umbilicus by retractors. We accomplished the dissection, resection and reconstruction mainly via the mini-laparotomy using a direct view and a laparoscopic image. RESULTS: Two cases were converted to open. The operative time was significantly longer in D1 + a (225 +/- 49 min) than in D1 (172 +/- 38 min). Blood loss was significantly more in D1 + a (247 +/- 155 mL) than in D1 (109 +/- 60 mL). There was no difference between the two groups in terms of days to first flatus, first oral intake or discharge from the hospital. Postoperative complications included 2 wound infections each in D1 and D1 + a group, and 1 anastomotic stenosis in D1 + a group. CONCLUSIONS: Gasless laparoscopy-assisted distal gastrectomy with D1 + a via mini-laparotomy using abdominal wall lift seems to be feasible and useful for early gastric cancer.