Initial experience of single-incision plus one port left-side approach totally laparoscopic distal gastrectomy with uncut Roux-en-Y reconstruction

Wei Zhou, Chang-Zheng Dong, Yi-Feng Zang, Ying Xue, Xing-Guo Zhou, Yu Wang, Yin-Lu Ding, Wei Zhou, Chang-Zheng Dong, Yi-Feng Zang, Ying Xue, Xing-Guo Zhou, Yu Wang, Yin-Lu Ding

Abstract

Background: Single incision plus one port left-side approach (SILS+1/L) totally laparoscopic distal gastrectomy (TLDG) is an emerging technique for the treatment of gastric cancer. Reduced port laparoscopic gastrectomy has a number of potential advantages for patients compared with conventional laparoscopic gastrectomy: relieving postoperative pain, shortening hospital stay and offering a better cosmetic outcome. Nevertheless, there are no previous reports on the use of SILS+1/L TLDG with uncut Roux-en-Y (uncut R-Y) reconstruction.

Aim: To investigate the initial feasibility of SILS+1/L TLDG with uncut Roux-en-Y digestive tract reconstruction (uncut R-Y reconstruction) to treat distal gastric cancer.

Methods: A total of 21 patients who underwent SILS+1/L TLDG with uncut R-Y reconstruction for gastric cancer were enrolled. All patients were treated at The Second Hospital of Shandong University. Reconstructions were performed intracorporeally with 60 mm endoscopic linear stapler and 45 mm no-knife stapler. The clinicopathological characteristics, surgical details, postoperative short-term outcomes, postoperative follow-up upper gastrointestinal radiography findings and endoscopy results were analyzed retrospectively.

Results: All SILS+1/L operations were performed by SILS+1/L TLDG successfully. The patient population included 13 men and 8 women with a mean age of 48.2 years (ranged from 40 years to 70 years) and median body mass index of 22.8 kg/m2. There were no conversions to open laparotomy, and no other port was placed. The mean operation time was 146 min (ranged 130-180 min), and the estimated mean blood loss was 54 mL (ranged 20-110 mL). The mean duration to flatus and discharge was 2.3 (ranged 1-3.5) and 7.3 (ranged 6-9) d, respectively. The mean number of retrieved lymph nodes was 42 (ranged 30-47). Two patients experienced mild postoperative complications, including surgical site infection (wound at the navel incision) and mild postoperative pancreatic fistula (grade A). Follow-up upper gastrointestinal radiography and endoscopy were carried out at 3 mo postoperatively. No patients experienced moderate or severe food stasis, alkaline gastritis or bile reflux during the follow-up period. No recanalization of the biliopancreatic limb was found.

Conclusion: SILS+1/L TLDG with uncut R-Y reconstruction could be safely performed as a reduced port surgery.

Keywords: Distal gastrectomy; Gastric cancer; Laparoscopy; Reduced port surgery; Single-incision plus one port; Uncut Roux-en-Y gastrojejunostomy.

Conflict of interest statement

Conflict-of-interest statement: We declare that there are no conflicts of interest to disclose.

©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.

Figures

Figure 1
Figure 1
Settlement of port for single incision plus one port left-side approach.
Figure 2
Figure 2
Procedures of reconstruction. A: The gastrojejunal anastomosis; B: The jejunojejunal anastomosis; C: Closing the gastrojejunal anastomosis; D: Uncut reconstruction.
Figure 3
Figure 3
Appearance of the abdomen after surgery.
Figure 4
Figure 4
Appearance of the abdomen 3 mo after surgery.
Figure 5
Figure 5
Upper gastrointestinal imaging examination 3 mo after surgery: No jejunal recanalization.
Figure 6
Figure 6
Endoscopic examination. A: Minimal food stasis; B: Alkaline gastritis around the gastrojejunal anastomosis.
Figure 7
Figure 7
Learning curve: Operation time plotted against case number.
Figure 8
Figure 8
Learning curve: Blood loss plotted against case number.

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