Dissection Experience Research Articles

Outermost layer-oriented medial approach for infrapyloric nodal dissection in laparoscopic distal gastrectomy.

Based on our experience of suprapancreatic nodal dissection in laparoscopic gastrectomy, we developed an outermost layer-oriented medial approach for infrapyloric nodal dissection. The objective of this single-institution retrospective study was to determine the feasibility, safety, and reproducibility of this novel and unique dissection procedure. This approach can be performed in the same manner as suprapancreatic nodal dissection but by replacing the left gastric artery with the right gastroepiploic artery (RGEA), the common hepatic artery with the anterior superior pancreaticoduodenal artery (ASPDA), and the splenic artery with the gastroduodenal artery. It comprises five steps: (1) mobilization of the transverse mesocolon along the prepancreatic membrane, (2) medial dissection along the dissectable layer between the pancreatic head and the dorsal side of the right gastroepiploic vein (RGEV), (3) division of the RGEV and determination of the lateral and cranial borders, (4) dissection along the outermost layer of the RGEA and ASPDA and transection of the infrapyloric artery and RGEA, and (5) transection of the duodenal bulb. This novel method was applied in 112 patients who underwent laparoscopic distal gastrectomy from 2014 to 2015. The anatomical landmarks that we determined to appropriately identify the outermost layer were highly reproducible, and our novel procedure based on these landmarks was successfully completed in all cases, without any intraoperative complications. Furthermore, in all cases, no. 6 lymph nodes were fully and adequately dissected within the infrapyloric area anatomically defined in the Japanese Classification of Gastric Carcinoma ver. 14. Pancreatic fistula occurred only in 1.8% cases. This novel outermost layer-oriented medial approach is a robust procedure that may help laparoscopic surgeons in performing safe and reproducible infrapyloric nodal dissection.

Pathology Findings in Medical School Anatomy Cadavers

This article was migrated. The article was not marked as recommended. With more medical schools in the United States and abroad turning to virtual anatomy instead of gross dissection of actual cadavers, unexpected pathological findings may not be encountered as teaching opportunities. By using real cadavers the cause of death information provided might confirm pathology which is found in the course of routine anatomical dissection. Additional pathology not attributable to cause of death adds further to the experience of the cadaver dissection. Over the course of four academic years, human cadavers at New York Institute of Technology College of Osteopathic Medicine were sampled based on encountered gross pathological findings. Over the four years, there were 64 cadavers sampled randomly and forty two percent of the cadavers had findings related to cause of death. Sixty-six percent of the cadavers had findings which were not related to the cause of death. Thus, not only is pathology abundant in human anatomy cadavers and a source of important medical education but additional pathology outside of cause of death is an even greater source of teaching material. The benefits of human anatomy dissection are good medical educational sources with or without clinical information in the form of cause of death. Having limited clinical information may further enhance the educational value of anatomy dissection.

Use and perceptions of plastination among medical anatomy educators in the United States.

Traditionally, medical schools have maintained collections of tissues/organs to engage students in anatomy. Such collections are often stored in volatile and toxic preservatives. Plastination is an alternative tissue preservation technique in which polymers replace water and lipids resulting in benign, dry, and anatomically authentic specimens. Plastination is used in medical education internationally; however, its use within U.S. medical schools is not widely discussed in the anatomical literature. This study aimed to determine the knowledge, use, and perceptions of plastination as a teaching tool among U.S. anatomy medical educators. A total of 98 medical anatomy educators who fit inclusion criteria and teach allopathic (MD) students and/or osteopathic (DO) students in the United States completed a national survey, representing 77 medical schools across 37 states. Of these, 100% had heard of plastination, 57% correctly defined plastination, but only 39% currently utilize plastinates for anatomy education. The most frequent explanation for nonuse of plastinates was a preference for the dissection experience, followed by lack of resources and negative past experiences related to durability and quality. A majority (75%) of U.S. medical anatomy educators perceived plastination as a good supplement to, but not a replacement for, cadaveric dissection, 19% indicated no curiosity to use plastination or considered it not useful, and 14% expressed ethical concerns. These findings suggest plastinates are more widely used in the United States than reflected by the literature; however, perceptions regarding their utility indicate a dominant theme for their use to supplement, not replace, cadaveric dissection. Clin. Anat, 2017. © 2017 Wiley Periodicals, Inc.

Cross-Institutional Evaluation of a Mastoidectomy Assessment Instrument

The objective of this work is to obtain validity evidence for an evaluation instrument used to assess the performance level of a mastoidectomy. The instrument has been previously described and had been formulated by a multi-institutional consortium. Mastoidectomies were performed on a virtual temporal bone system and then rated by experts using a previously described 15 element task-based checklist. Based on the results, a second, similar checklist was created and a second round of rating was performed. Twelve otolaryngological surgical training programs in the United States. In all, 65 mastoidectomy performances were evaluated coming from 37 individuals with a variety of temporal bone dissection experience, from medical students to attending physicians. Raters were attending surgeons from 12 different institutions. Intraclass correlation scores varied greatly between items in the checklist with some being low and some being high. Percentage agreement scores were similar to previous rating instruments. There is strong evidence that a high score on the task-based checklist is necessary for a rater to consider a mastoidectomy to be performed at the level of an expert but a high score is not a sufficient condition. Rewording of the instrument items to focus on safety does not result in increased reliability of the instrument. The strong result of the Necessary Condition Analysis suggests that going beyond simple correlation measures can give extra insight into grading results. Additionally, we suggest using a multiple point scale instead of a binary pass/fail question combined with descriptive mastery levels.

Endoscopic Submucosal Tunnel Dissection for Lesser Gastric Curvature Superficial Neoplasms: 2017 Presidential Poster Award

Introduction: Endoscopic submucosal dissection (ESD) has been widely used for resection of gastrointestinal neoplastic lesions, but there are still technical challenges in treating large ones especially located in lesser gastric curvature. In the tunnel technique, incisions at the lower and upper lesion edges are joined by a submucosal tunnel and then lateral incisions are made. The mucosa is thereby easily separated from the muscular layer. We report our experience of endoscopic submucosal tunnel dissection (ESTD) in lesser gastric curvature. Methods: 47 patients with lesser curvature superficial neoplasms undergoing endoscopic resection were analyzed retrospectively. 26 patients underwent ESTD and 21 received ESD. Operation time, security, En bloc resection rate and complications were compared between the two groups. The major difference between ESTD and ESD is that, instead of pre-cutting circumferential mucosal, a submucosal tunnel was created by submucosal dissection from the oral incision to the anal incision. Bilateral resection was then performed to remove the lesion completely. Results: The differences between the two groups in the age of the patients and the diameter of the lesions had no statistically significant (P > 0.05). En bloc resection rate was 100% in the study group and 90.5% in the control group (19/21), and the difference was statistically significant (P < 0.05). The average operation time was 46 minutes (36˜59 minutes), the control group was77 minutes (48˜110 minutes), the difference was statistically significant (P < 0.05). The intraoperative bleeding rate of the study group was 57.7% (15/26), the control group was 100%, the difference was statistically significant (P < 0.05). The incidence of perforation was 0% in the study group and 9.5% in the control group (2/21), and the difference was statistically significant (P < 0.05). There was 1 case of delayed bleeding after operation in the two groups, there were no postoperative perforation, and the difference was not statistically significant (P > 0.05). There were no recurrence and metastasis in the two groups after the operation. Conclusion: In contrast to ESD, ESTD shows larger working space, shorter operating time, lower perforation and hemorrhage rate. Patients can recover quicklier so that the length of hospital stay can be decreased. The application prospect of ESTD is promising, especially for those tumors with lager size, and further investigation should be conducted.Figure: The lesion located in lesser gastric curvature.Figure: A submucosal tunnel was created by submucosal dissection from the oral incision to the anal incision.

Limited root repair in acute type A aortic dissection is safe but results in increased risk of reoperation

ObjectiveManagement of the aortic root is a challenge for surgeons treating acute type A aortic dissection. MethodsWe performed a retrospective review of the acute type A aortic dissection experience at Stanford Hospital between 2005 and 2015 and identified patients who underwent either limited root repair or aortic root replacement. Differences in baseline characteristics were balanced with inverse probability weighting to estimate the average treatment effect on the controls. Weighted logistic regression was used to evaluate in-hospital mortality. Weighted Cox proportional hazards regression was used to evaluate differences in the hazard for mid-term death. Reoperation was evaluated with death as a competing risk with the Fine-Gray subdistribution hazard. ResultsAfter we excluded patients managed either nonoperatively or with definitive endovascular repair, there were 293 patients without connective tissue disease who underwent either limited root repair or aortic root replacement. There was no difference in weighted perioperative mortality, odds ratio 0.89 (95% confidence interval [CI], 0.44-1.76, P = .7), and there was no difference in weighted survival, hazard ratio 1.12 (95% CI, 0.54-2.31, P = .8). Risk of reoperation was greater in limited root repair (11.8%, 95% CI, 0.0%-23.8%) than for root replacement (0%), P < .001. ConclusionsLimited root repair was associated with increased risk of late reoperation after repair of acute type A aortic dissection. Surgeons with adequate experience may consider aortic root replacement in well-selected patients. However, given good outcomes after limited root repair, surgeons should not feel compelled to perform this more-complex operation.

Clinical experience in treatment of the isolated abdominal aortic dissection

Objective This retrospective study is to analyze and summarize the clinical features and therapeutic experience of the isolated abdominal aortic dissection(IAAD). Methods Totally 17 patients of IAAD, who were admitted to our hospital from January 2009 to January 2016, were included in this retrospective analysis. Five patients with obvious pain or abdominal aorta diameter of 30 mm accompanied with sub-renal anchorage area of 15 mm, underwent endovascular repair. In these 5 patients, 4 cases were subjected to bifurcated stent graft endovascular repair and 1 case received the aorta uni-iliac endovascular repair combined with femoral-femoral artery bypass treatment. Moreover, 2 patients with sub-renal anchorage area of less than 15 mm were subjected to surgical treatment. In these 2 patients, 1 case with obvious pain and abdominal aorta diameter of 30 mm underwent the abdominal aorta-right iliac artery bypass combined with femoral-femoral artery bypass, while the other case with abdominal aorta diameter of 30 mm but no pain received the abdominal aorta-bilateral iliac artery bypass. Furthermore, 8 patients with no obvious pain and abdominal aorta diameter of less than 30 mm received conservative medical treatment. In addition, there were 2 patients with obvious pain and abdominal aorta diameter of 30 mm suffering from sudden death during the surgical preparation. Important complications of these patients during hospitalization and follow-up period were recorded, analyzed, and compared. Results For the 5 patients undergoing endovascular repair, the averaged hospitalization duration was (15.4±2.9) d, one of whom died during hospitalization. There were 3 cases with follow-up period of ≥ 12 months, and 1 case reported left iliac branch occlusion. For the 2 patients subjected to surgical treatment, the follow-up period was less than 12 months, and no serious complications occurred during hospitalization or follow-up period. For the 8 patients receiving conservative medical treatment, the averaged hospitalization duration was (11.1±5.2) d. There were 4 cases with follow-up period of ≥ 12 months, and no serious complications occurred during hospitalization or follow-up period. Conclusions Endo or open surgical treatment is recommended for patients with isolated abdominal aortic dissection with obvious pain or abdominal aortic diameter of 30 mm. For the patients with no pain and abdominal aortic diameter of less than 30 mm, conservative medical treatment is recommended. Key words: Aneurysm, dissecting; Aorta, abdominal; Clinical protocols; Comparative effectiveness research

A Method for Maximizing Dissection Experience with a Minimal Number of Cadavers in an Undergraduate Human Gross Anatomy Laboratory Course

A Method for Maximizing Dissection Experience with a Minimal Number of Cadavers in an Undergraduate Human Gross Anatomy Laboratory Course

How Cardiac Anesthesiology Can Help “STEM” the Tide of Under-representation of Minorities in Science and Medicine

The field of medicine is built upon science, technology, engineering, and math (STEM), yet the United States is rapidly falling behind when it comes to educating the next generation in these disciplines, especially under-represented populations. The authors reflect on existing educational literature surrounding efforts to promote interest in STEM among students and under-represented populations. The authors advocate for greater efforts toward the development of youth programing. Cardiac anesthesia is uniquely positioned as a subspecialty to advance the goal of promoting interest in STEM in diverse groups of young students. The authors describe their development and implementation of a community outreach program to enhance interest in medicine through a cardiac dissection experience.

Can Endoscopic Ulcerations in Early Gastric Cancer Be Clearly Defined before Endoscopic Resection? A Survey among Endoscopists.

Background/AimsEarly gastric cancer (EGC) with ulcerations can be treated via endoscopic resection (ER) when it is differentiated pathologically, limited to the mucosa, and <3 cm in diameter. The presence of ulceration is a key factor in deciding treatment strategies and is usually diagnosed during endoscopic examination. The aim of this study was to evaluate whether ulcerations in EGC can be clearly defined among endoscopists and which factors are related to the differences.MethodsA survey questionnaire, composed of demographic features and endoscopic images of seven patients with EGC, was presented to the endoscopists via e-mail. The endoscopists were asked whether such patients have ulcerations in the lesions.ResultsThe questionnaires were e-mailed to 197 endoscopists, and 103 doctors replied. The presence of an endoscopic ulceration was defined differently among the endoscopists, depending on the duration of endoscopic practice and the experience of endoscopic submucosal dissection. The differences were especially high in the lesions without mucosal breaks and converging folds, which were expected to be viewed as non-ulcerative.ConclusionsBefore ER, endoscopic ulcerations in EGC must be reviewed by experienced endoscopists to reduce overestimations, and adequate educational programs for trainees should be established.

Perceptions of Dissection Experience in a Professional Veterinary Curriculum

Many similarities exist between medical and veterinary schools, particularly when it involves anatomy education. The professional identity of medical and veterinary professionals and students may, however, be quite different. Professional veterinary students are often exposed to and participate in euthanasias of client‐owned patients and of their own animals, both prior to and during their tenure in professional veterinary school. The experience of euthanasia is a longitudinal one comprised of three key elements: the decisions leading to the event, the event itself, and the aftermath. Each of these steps often require significant interactions between the veterinarian and the patient. This early and frequent exposure to death and dying, along with extensive literature supporting strong human‐animal bonds with many domestic species, make veterinary students an excellent resource for understanding the impact of cadaveric dissection‐intensive courses. The purpose of this study was to evaluate the emotional influence and impact of cadaveric anatomy dissection on veterinary students' experience. Students participating in a previously published, dissection‐based anatomy precourse were evaluated by repeated measures. Responses to open‐ended questions regarding students' anticipated reaction to dissection and participation within the precourse were collected. Following course completion, students were given an efficacy‐tested, previously published, mixed‐methods survey gauging their emotional response to dissection. Information regarding their previous dissection experience, as well as number and species of animals they owned, was also requested. Fifty‐four students participated in the precourse. There was a 100% response rate for the pre‐survey, and a 98% response rate for the post‐survey. Pre‐survey results indicated students were excited for a variety of reasons including: increasing knowledge, hands‐on experiences, and the strong perceived relationship between anatomy and their future careers. The few students who did express concern focused more on the overwhelming quantity of knowledge associated with anatomy. Post‐survey Likert results indicated students had very few negative reactions to the dissection process, and instead focused on an excitement for learning. The large majority indicated they were able to detach themselves from the dissection experience. Qualitative results suggest that this emotional detachment does not apply to their excitement about learning. These results indicate that veterinary students may not experience as many negative emotions as students who dissect human cadavers, according to current reports. Given the similarities between the human‐animal bond to the human‐human bond, these findings suggest that the decreased anxiety may be influenced by the increased experiences with death and dying in the context of euthanasia. Future studies will explore this premise further and evaluate the transferability of outcomes to the medical school setting.

Student Performance in and Perception of Gross Anatomy in Varied Curricular Material Organization in Multiple Cohorts

PURPOSEThe first and second year curriculum at Mercer University School of Medicine provides students an opportunity to learn the subject material in a Problem Based Learning case format. The Musculoskeletal Phase provides students with their first Gross Anatomy Laboratory dissection experience. This study looks at student performance when one group of students followed a case order that paralleled the laboratory dissection sequence (Dissection) compared to that of one which did not (Traditional). This study also evaluated student perception of their learning experiences in the Anatomy Laboratory.RESULTSStudy participants were found in two different cohorts (2017 and 2018 graduating classes). Students in the Dissection group (n=132) scored a Gross Anatomy average of 78.15 and an overall phase average of 79.39. Students in the Traditional group (n= 81) had a Gross Anatomy average of 79.98 and an overall Phase average of 79.88. The results indicate that the case order presentation does not significantly alter the overall student performance within the discipline (p= 0.178) or the Phase (p= 0.566). One hundred thirty out of the 213 students participated in the survey assessing their perception of the learning experience within the Phase. Students felt laboratory was helpful in learning the phase material and that they would prefer to dissect in the same order as the PBL cases were presented. Those students within the Dissection group felt more prepared for laboratory experiences compared to their Traditional order counterparts.CONCLUSIONSOrder of case presentation does not have an effect on student performance in the discipline or examination as a whole.

Laparoscopic Repair of Post-cholecystectomy Bile Duct Injury: an Advance in Surgical Management

Despite widespread advances in laparoscopic surgery, laparoscopic repair of post-cholecystectomy bile duct injury (BDI) has rarely been reported related mainly to technical difficulty. We describe three cases of BDI treated laparoscopically with one illustrated by a video. With our gained experience in hepatic pedicle dissection during laparoscopic pancreaticoduodenectomy, we decided to perform laparoscopic repair of BDI in patients with an intact biliary confluence without vascular injury. Three patients were operated including two women: one was re-operated by subcostal incision for peritonitis and two had undergone cholecystectomy without conversion. Surgical technique is detailed in the manuscript and the video. Laparoscopic repair was performed between 45 and 300 days after cholecystectomy. Surgery lasted between 250 and 270 min with no conversion and no transfusion. The postoperative course was uneventful with a hospital stay ranging from 7 to 9 days. After a mean follow-up of 9–33 months, patients were symptom free with normal liver function tests. The laparoscopic approach can be safely and effectively proposed to a subgroup of patients with BDI. This approach has the advantages of the laparoscopic approach and represents the main new surgical advancement in the management of this complication.

Axillobifemoral Bypass Graft: A Student Dissection Experience.

As first-year medical students, we were excited, but nervous, to start the anatomy course. We were prepared to dedicate ourselves to the physical demands of dissection, and the hours of memorizing names and relations of countless anatomic features. We expected to leave the anatomy course with a comprehensive understanding of the human body that we would apply to our future studies and careers. We were not prepared, however, for the experience we had with our cadaver, Lucy.* Lucy was a small woman, but as we learned, she had endured a lot, physically and medically, in her 83 years of life. She had a pacemaker. She had coronary artery disease and a triple bypass procedure. She also had severe peripheral artery disease and had undergone at least one extraordinary surgical graft procedure to maintain blood flow into her lower extremities. The surprise of discovering a small piece of an axillobifemoral bypass graft and then continuing to uncover it, region by region, throughout the anatomy course, brought our dissection experience and our connection to Lucy to a more profound level than we could ever have anticipated. *The name Lucy was chosen as a pseudonym to protect the identity of the cadaver.

Analysis of the learning curve for peroral endoscopic myotomy for esophageal achalasia: Single-center, two-operator experience.

Peroral endoscopic myotomy (POEM) has emerged as an advanced technique for the treatment of achalasia, and defining the learning curve is mandatory. From August 2011 to June 2014, two operators in our institution (A&B) carried out POEM on 35 and 33 consecutive patients, respectively. Moving average and cumulative sum (CUSUM) methods were used to analyze the POEM learning curve for corrected operative time (cOT), referring to duration of per centimeter myotomy. Additionally, perioperative outcomes were compared among distinct learning curve phases. Using the moving average method, cOT reached a plateau at the 29th case and at the 24th case for operators A and B, respectively. CUSUM analysis identified three phases: initial learning period (Phase 1), efficiency period (Phase 2) and mastery period (Phase 3). The relatively smooth state in the CUSUM graph occurred at the 26th case and at the 24th case for operators A and B, respectively. Mean cOT of distinct phases for operator A were 8.32, 5.20 and 3.97 min, whereas they were 5.99, 3.06 and 3.75 min for operator B, respectively. Eckardt score and lower esophageal sphincter pressure significantly decreased during the 1-year follow-up period. Data were comparable regarding patient characteristics and perioperative outcomes. This single-center study demonstrated that expert endoscopists with experience in esophageal endoscopic submucosal dissection reached a plateau in learning of POEM after approximately 25 cases.

Does the experience of anatomical dissections change the mind of students? The opinion of Milanese undergraduate students towards the donation of bodies for didactic purposes

Anatomical dissections have always represented an important cornerstone of medical education, especially in anatomy [1,2]. However, in several universitary context their practice has been abandoned or even not yet introduced. In the University of Milan a limited program of body donation has existed since 2014 (PANDORA, Programma Anatomico di Donazione di Cadaveri a Scopo di Ricerca Antropologica e Biomedica) and therefore only in the last four years medical students have been able to take advantage from this crucial experience. This study aims at exploring the willingness of Italian undergraduate students towards whole body donation in order to ascertain the role of dissection in modifying the opinion: two groups of students belonging to the degree course in medicine and surgery were recruited. The first group included 43 students who were informed concerning the importance of dissection in anatomy through a specific course. The second group included 29 students admitted to a didactic autopsy. Students belonging to the two groups were then requested to specify if they would give their consent to the donation of their bodies, and why. Results showed that students who attended the dissection were more likely to show willingness towards body donation (60.7% versus 39.5%). Among positive opinions towards donation the percentage of persons who found the experience useful increased from 47.1% in the first group to 80% in the second group. On the other hand, among negative opinions, percentages of persons reporting bad feeling towards the dissection increased from 16.7% in the first group to 27.2% in the second group. This study shows that experience of dissection is a crucial step for emotional and professional improvement of medical students and contributes in a more detailed definition of their own opinion concerning body donation.

Fascial recognition: An interview with Laurie Booth

Abstract An interview that explores Laurie Booth’s background in dance and improvisation and his new work in the field of myofascial movement training that is informed by cutting edge science in the field of fascia and his own experience of cadaver dissection. Booth talks about the connection between the fascia training and his approach to creative dance movement and the importance of keeping moving as we age.

A study of Nursing Students’ Observation Experiences of Human Body Dissection

Objectives: It is an epistemological and qualitative study on the experience of nursing students in the observation of anatomy, where the participants described their experience. Methods/Statistical Analysis: The results of the study were analyzed after collecting data on nursing students’ experience in practice classes for the human anatomy. By applying analytical methods of Colaizzi, a total of 89 significant statements were concluded from the protocols, and 34 formulated meanings were extracted. Based on this, the association with the source data was verified to determine 13 themes. Among these themes, cluster of themes were formed by grouping four of them together. Findings: In the midst of the preparatory waiting step of the human anatomy lab practice, the participants recognized it as a major new opportunity associated with the vague concern and stress and geared themselves for the preparation of it. Applications/Improvements: This study are expected to provide better understanding of the physical and mental responses by nursing students in practice courses on anatomy.

Ten-year experience of esophageal endoscopic submucosal dissection of superficial esophageal neoplasms in a single center.

Background/AimsEndoscopic submucosal dissection (ESD) of a superficial esophageal neoplasm (SEN) is a technically difficult procedure. We investigated the clinical outcomes of ESD to determine its feasibility and effectiveness for the treatment of SEN.MethodsPatients who underwent ESD for SEN between August 2005 and June 2014 were eligible for this study. The clinical features of patients and tumors, histopathologic characteristics, adverse events, results of endoscopic resection, and survival were investigated.ResultsESD was performed in 225 patients with 261 lesions, including 70 cases (26.8%) of dysplasias and 191 cases (73.2%) of squamous cell carcinomas. The median age was 65 years (range, 44 to 86), and the male to female ratio was 21.5:1. Median tumor size was 37 mm (range, 5 to 85) and median procedure time was 45 minutes (range, 9 to 160). En bloc resection was performed in 245 of 261 lesions (93.9%), with complete resection in 234 lesions (89.7%) and curative resection in 201 lesions (77.0%). Adverse events occurred in 33 cases (12.6%), including bleeding (1.5%), perforation (4.6%), and stricture (6.5%). During a median follow-up period of 35.0 months (interquartile range, 18 to 62), none of the patients showed local recurrence. The 5-year overall and disease-specific survival rates were 89.7% and 100%, respectively.ConclusionsESD is a feasible and effective procedure for the treatment of SEN based on our 10-year experience, which showed favorable outcomes.

Perspective of new techniques overcoming laparoscopic sentinel node biopsy for early gastric cancer.

The modern standard curative procedure for early gastric cancers falling outside the indication parameters for endoscopic resection is laparoscope-assisted gastrectomy with lymph node dissection. Patients undergoing standard gastrectomy with lymph node dissection experience postgastrectomy symptoms. These symptoms often pose life-long problems for patients. Thus, lymph node dissection should be avoided to preserve the stomach, alleviate the aforementioned symptoms, and improve postoperative quality of life. At present, sentinel lymph node (SN) biopsy is the most reliable method for identification of node-negative cases.