Reduced-port Laparoscopic Gastrectomy Research Articles

The Impact of Overweight and Obesity on Reduced-Port Laparoscopic Distal Gastrectomy for Gastric Cancer Patients: A Propensity Score Matching Analysis of a Single-Institution Data.

This study aimed to investigate the short-term postoperative outcomes of reduced-port laparoscopic distal gastrectomy and demonstrate its safety and feasibility in overweight and obese patients with gastric cancer. The medical records of 211 patients who underwent reduced-port laparoscopic distal gastrectomy, between August 2014 and April 2020, were reviewed. After propensity score matching, they were divided into a non-overweight group (n = 68) and overweight group (n = 68). Operative details and short-term surgical outcomes were compared between two groups. Reduced-port laparoscopic distal gastrectomy in overweight group showed statistically longer operation time (200.59 vs. 208.68 min, p = 0.044), higher estimated bleeding volume (40.96 vs. 58.01 mL, p = 0.001), and lesser number of harvested lymph nodes (36.81 vs. 32.13, p = 0.039). However, no significant differences were found in hospital course and other surgical outcomes. There was no mortality in either group, and the postoperative morbidity rate was not significantly different (14.7% vs. 16.2%). In the subgroup analysis, overweight and obesity did not significantly affect postoperative complication rates (16.2% vs. 16.2%, p = 1). We demonstrated comparable short-term surgical outcomes of reduced-port laparoscopic distal gastrectomy between the two groups (p = 0.412~1). Reduced-port laparoscopic distal gastrectomy was safe in overweight and obese patients with gastric cancer.

Comparison of clinical safety and feasibility between reduced-port laparoscopic radical gastrectomy and conventional laparoscopic radical gastrectomy: A retrospective study.

BackgroundTraditional open gastric cancer surgery has evolved from porous to reduced-hole, single-hole, or even natural cavity surgery to laparoscopic surgery, due to the continuous development of minimally invasive concepts and medical technologies, as well as awareness for the concept of rapid recovery. Conventional laparoscopic radical gastrectomy is quite mature in age at the moment, but how to progress to minimally invasive surgery without increasing the difficulty of surgery while ensuring clinical safety and feasibility is worth further investigation. Therefore, the clinical safety and feasibility of reduced port laparoscopic radical gastrectomy were assessed in this study.MethodsInformation on the clinical data of patients undergoing laparoscopic radical gastric cancer surgery in a single centre between May 2020 and May 2022 was collected, and a total of 232 patients were included in this study according to the study protocol design. The clinical data of 232 patients with gastric cancer treated by two different surgical methods, namely, reduced port laparoscopic surgery (RPLS) or conventional laparoscopic surgery (CLS), were retrospectively analysed. The intraoperative indices, postoperative pathological indices, and short-term postoperative complications (within 30 days) of the two different surgical methods were evaluated, as well as the surgical methods’ feasibility and short-term postoperative recovery effect.ResultsThere was no significant difference between the general data of patients with RPLS and CLS (P > 0.05). Compared with CLSG, the operation time, digestive tract reconstruction time and lymph node dissection time of RPLSG are shorter. The intraoperative blood loss was less, and the incision was minimally invasive (P < 0.05). In the short-term postoperative effect, the level of white blood cell count on the first day, the time of getting out of bed, the time of removing drainage tube, the time of hospitalization and the VAS of pain on the first, third and fifth days after operation, RPLSG was obviously superior to CLSG (P < 0.05). There was no significant difference between RPLSG and CLSG in terms of pathological indices (P > 0.05).ConclusionsThe treatment of gastric cancer with RPLS has good safety, feasibility and short-term postoperative effects, which is in line with the implementation of the modern concept of rapid rehabilitation surgery.

Safety and effectiveness of reduced-port laparoscopic sleeve gastrectomy in Asian morbidly obese patients

Laparoscopic sleeve gastrectomy is the most frequently performed surgical intervention in patients with morbid obesity. Single-port sleeve gastrectomy (SPSG) and reduced-port sleeve gastrectomy (RPSG) are increasingly reported in the literature. This study compared the short-term outcomes of SPSG, RPSG, and conventional laparoscopic sleeve gastrectomy (CLSG). This is a single-center retrospective study of 238 morbidly obese patients, of whom 148 (62.2%) patients completed follow-up one year after surgery. Propensity score matching was performed on factors influencing the choice of approach, and fifty patients from the SPSG + RPSG and CLSG groups were successfully matched. The groups were comparable in postoperative weight loss, morbidity, pain, and resolution of obesity-related comorbidities. The percentage of excess weight loss after one year was 90.0% in the SPSG + RPSG group and 75.2% in the CLSG group (P < 0.001). Complication rates showed no significant difference. The CLSG group was superior in dyslipidemia remission (17 [37.0%] vs. 28 [63.6%], P = 0.018) in the total cohort; however, this difference disappeared after matching. Our results suggest that single-port and reduced-port approaches could be alternative choices for selected patients. As our study was limited by its retrospective nature and potential selection bias, further studies are necessary to set standardized guidelines for SPSG.

Actual 3-Year Survival After Reduced-Port Laparoscopic Distal Gastrectomy for Gastric Cancer (RpLDG): a Propensity Score Matching Analysis

BackgroundTotal laparoscopic distal gastrectomy for early gastric cancer has been widely accepted; however, reduced-port laparoscopic distal gastrectomy has not gained the same popularity because of technical difficulties and oncologic safety issues. This study aimed to analyze the oncologic safety and short-term surgical outcomes of patients who underwent reduced-port laparoscopic distal gastrectomy (RpLDG) for gastric cancer. MethodsConsecutive patients who underwent surgical treatment between January 2016 and May 2018 were included in this study. Of the 833 patients enrolled, 158 underwent RpLDG and were propensity-matched with 158 patients who underwent conventional port laparoscopic distal gastrectomy (CpLDG). The groups were compared in terms of short-term outcomes and disease-free and overall survival rates. ResultsThe RpLDG group had shorter operation times (161.8 min vs. 189.0 min, p < 0.00) and shorter postoperative hospital stays (7.6 days vs. 9.1 days, p = 0.04) compared to the CpLDG group. Estimated blood loss was lower in the RpLDG group than in the CpLDG group (52.6 mL vs. 73.7 mL, p < 0.00), while hospital costs incurred by the RpLDG group were lower than those of the CpLDG group (10,033.7 vs. 11,016.8 USD, p < 0.00). No statistical differences were found regarding overall morbidity and occurrence of surgical complications of grade III or higher, as defined by the Clavien-Dindo classification. Furthermore, no significant differences between RpLDG and CpLDG were found in 3-year disease-free (99.4% vs. 98.1%; p = 0.42) and 3-year overall survival rates (98.7% vs. 96.8%; p = 0.25). ConclusionPatients who underwent RpLDG had better short-term surgical outcomes than those who underwent CpLDG in terms of operation time, estimated blood loss, duration of hospital stay, and hospital costs. The oncologic safety of RpLDG was satisfactory.

Reduced-port laparoscopic distal gastrectomy in obese gastric cancer patients.

Reduced-port laparoscopic gastrectomy is currently widely performed for patients with gastric cancer. However, its safety in obese patients has not yet been verified. This is the first study on reduced-port laparoscopic distal gastrectomy (RpLDG) in obese patients with gastric cancer. This study aimed to evaluate the short-term surgical outcomes and investigate the feasibility and safety of RpLDG in obese patients with gastric carcinoma. A total of 271 gastric cancer patients who underwent RpLDG at our institution were divided into two groups: non-obese [body mass index (BMI) <30 kg/m2, n = 251; NOG] and obese (BMI ≥30 kg/m2, n = 20; OG). The mean age of the enrolled patients was 64.8 ± 11.4 years, with 72.0% being men and 28.0% women. Operative details and short-term surgical outcomes, including hospital course and postoperative complications, were compared by retrospectively reviewing the medical records. No significant difference in operation time was found between the NOG and OG (205.9 ± 40.0 vs. 211.3 ± 37.3 minutes, P = 0.563). Other operative outcomes in the OG, including estimated blood loss (54.1 ± 86.1 vs. 54.0 ± 39.0 mL, P = 0.995) and retrieved lymph nodes (36.2 ± 16.4 vs. 35.5 ± 18.2, P = 0.875), were not inferior to those in the NOG. There were also no statistical differences in short-term surgical outcomes, including the incidence of surgical complications (13.9% vs. 10.0%, P = 1). RpLDG can be performed safely in obese gastric cancer patients by an experienced surgeon. It should be considered a feasible alternative to conventional port distal gastrectomy.

Comparing the surgical outcomes of dual-port laparoscopic distal gastrectomy and three-port laparoscopic distal gastrectomy for gastric cancer.

PurposeMany studies have demonstrated that single-incision or reduced-port laparoscopic distal gastrectomy is a feasible method compared to conventional laparoscopic distal gastrectomy. Using rigid-type laparoscope and right-side approach, we could perform dual-port laparoscopic distal gastrectomy (DPLDG) for gastric cancer. This study aimed to compare the surgical outcomes of DPLDG to those of 3-port laparoscopic distal gastrectomy (TPLDG).MethodsFrom March 2017 to December 2019, this retrospective study included 218 patients with gastric cancer who underwent DPLDG (106 patients) or TPLDG (112 patients) at SMG-SNU Boramae Medical Center. Surgical outcomes were compared between 2 operation methods.ResultsOperation time was similar between DPLDG and TPLDG (158.9 ± 33.4 minutes vs. 154.0 ± 31.1 min, P = 0.787). The number of retrieved lymph nodes was similar between the 2 groups (35.3 ± 14.6 vs. 37.0 ± 13.5, P = 0.415). The complication rate in DPLDG and TPLDG groups was 10.4% and 8.9%, respectively (P = 0.894). The time to first flatus, time to first diet, and postoperative hospital stay were similar between the 2 groups. There were no reoperation or mortality cases. The cost of trocars was 359.9 US dollars (USD) in DPLDG and 291–391.4 USD in TPLDG.ConclusionThe surgical outcomes of DPLDG and TPLDG did not differ. Regarding fewer incisions, DPLDG can be an alternative option for TPLDG.

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

BACKGROUNDSingle 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.AIMTo 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.METHODSA 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.RESULTSAll 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.CONCLUSIONSILS+1/L TLDG with uncut R-Y reconstruction could be safely performed as a reduced port surgery.

Reduced Port Laparoscopic Gastrectomy for Gastric Cancer

Reduced Port Laparoscopic Gastrectomy for Gastric Cancer

Comparison of Single-Incision Plus One Port Laparoscopic Distal Gastrectomy and Three-Port Laparoscopic Distal Gastrectomy for Gastric Cancer.

Background: Many studies demonstrated that single-incision or reduced-port laparoscopic distal gastrectomy is a feasible method compared to conventional laparoscopic distal gastrectomy. Using rigid type laparoscope, we could performed single-incision plus one port laparoscopic distal gastrectomy (SPOLDG) for gastric cancer. This study aimed to compare surgical outcomes of DILDG to those of three-port laparoscopic distal gastrectomy (TPLDG).

Lymphadenectomy using two instrument arms during robotic surgery for gastric cancer: A strategy to facilitate reduced-port robotic gastrectomy

Three instrument arms are used in the current form of reduced-port robotic gastrectomy (RPRG) for gastric cancer. Based on our experience in performing reduced-port laparoscopic gastrectomy (RPLG), we have recently performed RPRG using two instrument arms. From February 2018 to January 2019, we performed RPRG using two instrument arms for gastric cancer. One endoscope arm and two instrument arms of da Vinci® Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) were applied in robotic lymphadenectomy. A commercial multi-lumen single-port trocar was used for the endoscopy port. A total of 18 patients underwent the planned robotic surgery using two instrument arms. Median operation time was 288.5 (213.0-446.0) minutes, and median hospital stay was 11.0 (7-18) days. Four patients experienced postoperative complications: one Clavien-Dindo grade IIIa, and the other three grade II. No mortality was reported. The number of retrieved lymph nodes did not differ between patients who underwent RPRG and RPLG (p=0.412). Gastric cancer surgery using two instrument arms of a robotic surgical system can be performed by surgeons with expertise of RPLG. If this technique is successfully introduced in robotic surgery, it is expected to shorten the path to pure single-port robotic gastrectomy.

Analysis of technical difficulties of single-port and reduced-port laparoscopic radical gastrectomy for gastric cancer

Single-port and reduced-port laparoscopic radical gastrectomy as the innovative surgery for gastric cancer are gradually accepted nowadays, and more attentions are also paid to single-port and reduced-port laparoscopic radical gastrectomy due to its better cosmetic effect, less pain, lower incidence rate of surgical site infection and more advantages in enhanced recovery after surgery. However, in the early stage, the development of single-port and reduced-port laparoscopic radical gastrectomy were facing challenges and obstacles on account of limited surgical skills, the lack of special laparoscopic instruments, laparoscope and multi-port Trocar. In recent years, the dilemma and difficult situations were gradually resolved following by surgical techniques innovation, laparoscopic instruments and facilities improvement. It is believed that single-port and reduced-port laparoscopic radical gastrectomy will have a good prospect and breakthrough in the field of gastric cancer treatment in the future. Key words: Gastric neoplasms; Gastric cancer; Radical surgery; Laparoscopy; Single-incision and reduced-port; Technical difficulties

Reduced Port Technique for Bariatric Surgery Procedures: Feasibility, Technique and Outcome

Aim: Reduced Port laparoscopic Surgery (RPLS) involves fewer ports or narrower ports than standard laparoscopic surgery. It has the potential to cause reduced postoperative pain, reduce abdominal wall trauma and increase the aesthetic result without compromising the outcome. This review describes the feasibility, present situation and challenges faced as well as standardized procedures and the future prospects of reduced port laparoscopic gastrectomy for various bariatric procedure. Materials and methods: From December 2015 to January 2017, 251 patients were enrolled in our trial all of which underwent the procedure using the three port technique. All patients had morbid obesity with history of failure of conservative treatment. The aim was to assess and evaluate postoperative pain and patients’ satisfaction with the aesthetic results as well as to define the features of early post-operative complications of patients in comparison to the conventional five ports technique. Results: 251 patients were enrolled in our trial. The analyzed population included 185 women and 66 men. Mean age and BMI were 41 ± 23 and 53 ±18, respectively. Mean operative time was 47 ± 20 min for sleeve gastrectomy, 65±13 min for mini-gastric bypass and 133±25 min for revisional surgeries. Mortality was nil. Overall morbidity rate was recorded. Median duration of hospital stay was 1.5 days (range, 1–2) for sleeve gastrectomy and gastric bypass and 2.5 days (2-4 days) for revisional surgeries. Conclusion: Three ports technique for bariatric surgery is a safe and effective surgical option in patients with morbid obesity without additional early surgical complications or increase in operative time, and with a greater patient aesthetic satisfaction.

Reduced-port totally robotic distal subtotal gastrectomy with lymph node dissection for gastric cancer: a modified technique using Single-Site® and two additional ports.

Reduced-port laparoscopic gastrectomy further minimizes the invasiveness of laparoscopic gastrectomy, thereby improving patient quality of life. However, suboptimal ergonomics and visualization are challenges to performing reduced-port laparoscopy. As the application of a robotic surgical system may help overcome these challenges, the present study was performed to evaluate the short-term outcomes of reduced-port totally robotic distal subtotal gastrectomy. An initial 40 consecutive gastric cancer patients treated with reduced-port totally robotic distal subtotal gastrectomy with lymph node dissection from February 2016 to February 2017 were retrospectively reviewed. An overturned infraumbilical Single-Site® port and two additional abdominal ports were utilized. Clinicopathological characteristics and short-term surgical outcomes were analyzed to evaluate the safety and feasibility of the procedure. Patients comprised 23 (57.5%) males and 17 females. Mean age and body mass index were 54years and 23.7kg/m2, respectively. Preoperative clinical T stage was early in 22 patients and advanced (T2 or more) in 18 (45%) patients. No conversions to laparoscopic or open surgery and no additional port insertions were required. Eighteen patients (45%) underwent D2 lymph node dissection. All reconstructions after gastrectomy were made intracorporeally, including 34 (85%) Billroth I anastomoses. Mean operative time and blood loss were acceptable (210min and 49.9ml, respectively). The mean number of retrieved lymph nodes was 58.8. Postoperative clinical courses were acceptable for all patients, with no grade III or higher complications recorded. Reduced-port totally robotic distal subtotal gastrectomy with lymph node dissection was successfully applied and provided acceptable short-term postoperative results.

Transition from Conventional to Reduced-Port Laparoscopic Gastrectomy to Treat Gastric Carcinoma: a Single Surgeon's Experience from a Small-Volume Center.

PurposeThis study aimed to evaluate the surgical outcomes and investigate the feasibility of reduced-port laparoscopic gastrectomy using learning curve analysis in a small-volume center.Materials and MethodsWe reviewed 269 patients who underwent laparoscopic distal gastrectomy (LDG) for gastric carcinoma between 2012 and 2017. Among them, 159 patients underwent reduced-port laparoscopic gastrectomy. The cumulative sum technique was used for quantitative assessment of the learning curve.ResultsThere were no statistically significant differences in the baseline characteristics of patients who underwent conventional and reduced-port LDG, and the operative time did not significantly differ between the groups. However, the amount of intraoperative bleeding was significantly lower in the reduced-port laparoscopic gastrectomy group (56.3 vs. 48.2 mL; P<0.001). There were no significant differences between the groups in terms of the first flatus time or length of hospital stay. Neither the incidence nor the severity of the complications significantly differed between the groups. The slope of the cumulative sum curve indicates the trend of learning performance. After 33 operations, the slope gently stabilized, which was regarded as the breakpoint of the learning curve.ConclusionsThe surgical outcomes of reduced-port laparoscopic gastrectomy were comparable to those of conventional laparoscopic gastrectomy, suggesting that transition from conventional to reduced-port laparoscopic gastrectomy is feasible and safe, with a relatively short learning curve, in a small-volume center.

Three-Port Versus Five-Port Laparoscopic Distal Gastrectomy for Early Gastric Cancer Patients: A Propensity Score Matched Case-Control Study

ABSTRACTAim: The aim of this study was to evaluate the feasibility and safety of three-port laparoscopic distal gastrectomy (TP-LDG) as a reduced port laparoscopic gastrectomy. Materials and Methods: We retrospectively identified 146 patients preoperatively diagnosed with early gastric cancer who underwent five-port laparoscopic distal gastrectomy (FP-LDG) or TP-LDG between May 2013 and July 2016. A propensity score matching analysis was used to create patient groups (48 patients in each group) matched for sex, age, body mass index, previous abdominal surgery history, and American Society of Anesthesiologist score. The short-term surgical outcomes between TP-LDG and FP-LDG were compared. Results: The TP-LDG group had a statistically shorter umbilical wound length [3.4 (range, 3.0–4.0) cm vs. 3.9 (range, 3.7–4.0) cm, p = .000], shorter operative time [230 (range, 190–310) min vs. 250 (range, 180–320) min, p = .036], and lower estimated blood loss [68 (range, 20–180) mL vs. 80 (range, 40–150) mL, p = .005] compared to that in the FP-LDG group. However, there was no specific superiority regarding inflammatory profiles. Complication rates were also similar (8.4% TP-LDG vs. 12.6% FP-LDG, p = .504). Conclusions: TP-LDG is a feasible and safe surgical procedure for the patients with early gastric cancer and provides the benefit of better cosmesis.

A new contrivance of single port and reduced port gastrectomy for gastric cancer

Background: Single-port laparoscopic gastrectomy (SPG) and reduced-port laparoscopic gastrectomy (RPG) are favorably accepted by patients with early gastric cancer because of less pain, early recovery time, and improving quality of life. However, performing SPG or RPG has some technical difficulties. This article focuses on the contrivance of SPG and RPG with operation technique and on the advantages of the combination of pneumoperitoneum and abdominal wall-lift method. Methods: Ninety-five patients with preoperative stage IA gastric cancer underwent SPG and RPG with D1+ lymphadenectomy between April 2005 and May 2016 at Hiroshima Prefectural Hospital. Thirty patients underwent SPG, and 65 underwent RPG. Results: No significant differences in amount of blood loss [10–357 (mean: 67) vs. 4–470 (mean: 63) mg, P=0.591] and operation time [218–471 (mean: 323) vs. 238–467 (mean: 320) min, P=0.595] were found between the SPG and RPG groups. No significant differences were also between the two groups in terms of post-operative complication and cosmetic results. Conclusions: SPG was safety performed with our special surgical technique, and RPG was safety and easily performed with the wide working space provided by the combination of pneumoperitoneum and abdominal wall lifting method.

Advancement of single-port and reduced-port laparoscopic gastrectomy for gastric cancer: a systemic review

Advancement of single-port and reduced-port laparoscopic gastrectomy for gastric cancer: a systemic review

Advancement of single-port and reduced-port laparoscopic gastrectomy for gastric cancer: a systemic review

Background: Laparoscopic gastrectomy has been established as a surgical treatment option for early gastric cancer. Accumulation of experience performing a variety of laparoscopic surgeries enables surgeons to do less invasive surgery, including reduced port laparoscopic gastrectomy (RPLG) and single port laparoscopic gastrectomy (SPLG), to improve the quality of life in patients with gastric cancer. The aim of this study was to review techniques and outcomes of RPLG and SPLG, and to suggest further directions for minimally invasive gastrectomy. Methods: We searched several databases; MEDLINE/PubMed and EMBASE/Ovid using the following key words: gastrectomy; gastric cancer; laparoscopy, laparoscopic; reduced port; single port, single incision, single site, single, and one. Clinical trials and observational studies reporting RPLG or SPLG were included. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Results: Seven studies for RPLG and three studies for SPLG were included in this review. A total of 532 patients with gastric cancer were included in these studies: 384 in the RPLG studies, 148 in the SPLG studies. There were no significant differences regarding the number of retrieved lymph nodes (LN), length of hospital stay, postoperative diet course or the presence of postoperative complications between either RPLG or SPLG compared to conventional laparoscopic gastrectomy (CLG). RPLG patients had similar postoperative pain and SPLG patients had significantly less compared to CLG patients. Conclusions: RPLG and SPLG can be alternative to CLG, as less invasive approaches with acceptable postoperative outcomes. RPLG or SPLG might be considered as a bridge technique from CLG to robotic single port surgery or natural orifice transluminal endoscopic surgery (NOTES) for patients with gastrectomy.

A new contrivance of single port and reduced port gastrectomy for gastric cancer

Background: Single-port laparoscopic gastrectomy (SPG) and reduced-port laparoscopic gastrectomy (RPG) are favorably accepted by patients with early gastric cancer because of less pain, early recovery time, and improving quality of life. However, performing SPG or RPG has some technical difficulties. This article focuses on the contrivance of SPG and RPG with operation technique and on the advantages of the combination of pneumoperitoneum and abdominal wall-lift method. Methods: Ninety-five patients with preoperative stage IA gastric cancer underwent SPG and RPG with D1+ lymphadenectomy between April 2005 and May 2016 at Hiroshima Prefectural Hospital. Thirty patients underwent SPG, and 65 underwent RPG. Results: No significant differences in amount of blood loss [10–357 (mean: 67) vs. 4–470 (mean: 63) mg, P=0.591] and operation time [218–471 (mean: 323) vs. 238–467 (mean: 320) min, P=0.595] were found between the SPG and RPG groups. No significant differences were also between the two groups in terms of post-operative complication and cosmetic results. Conclusions: SPG was safety performed with our special surgical technique, and RPG was safety and easily performed with the wide working space provided by the combination of pneumoperitoneum and abdominal wall lifting method.

The surgical treatment of gastric cancer in the era of minimally invasive surgery.

Minimally invasive surgery is regarded as an alternative to conventional open surgery in gastric cancer. More and more surgeons devote their efforts to reduce surgical incision and acquire better recovery. Nowadays, laparoscopic distal gastrectomy has been the standard method for early stage cancer with remarkable advantage in short-term outcomes and is widely accepted by patients. The indication of laparoscopic gastrectomy has been extended to local advanced gastric cancer. However, the oncological safety has long been debated. Therefore, large scale randomized controlled clinical trials are ongoing to confirm the feasibility and safety in more advanced gastric cancer. With the accumulation of surgical experience and development of instrument, several advanced techniques, such as function preserving surgery, total laparoscopic anastomosis, sentinel node navigation surgery, robotic assisted surgery and reduced port laparoscopic gastrectomy have also been explored and applied to gastric cancer patient. All these techniques could modify the extent of surgery, reduce the risk of perioperative complications and generate potential better results in quality of life. Although recent studies have confirmed the feasibility and safety of each procedure, more evidence is required for further popularization of the newly technique. Herein we describe the current status and evidence for surgical treatment of gastric cancer in the era of minimally invasive surgery.