Single-port Laparoscopic Gastrectomy Research Articles

A randomized controlled trial of single-port versus multi-port laparoscopic distal gastrectomy for gastric cancer.

This prospective randomized trial compared the invasiveness of laparoscopic gastrectomy using a single-port approach with that of a conventional multi-port approach in the treatment of gastric cancer. The benefit of single-port laparoscopic gastrectomy (SLG) over multi-port laparoscopic gastrectomy (MLG) has yet to be confirmed in a well-designed study. One hundred and one patients who were scheduled to undergo laparoscopic distal gastrectomy for histologically confirmed clinical stage I gastric cancer between April 2016 and September 2018 were randomly allocated to SLG (n = 50) or MLG (n = 51). The primary endpoints were the postoperative visual analog scale pain scores. Secondary endpoints were frequency of use of analgesia, short-term outcomes, such as operating time, intraoperative blood loss, inflammatory reactions, postoperative morbidity, and 90-day mortality. The postoperative pain score was significantly lower in the SLG group than in the MLG group (p < 0.001) on the operative day and the postoperative day 1-7. Analgesics were administered significantly less often in the SLG group than in the MLG group (1 vs. 3days, p = 0.0078) and the duration of use of analgesics was significantly shorter in the SLG group (2 vs. 3days, p = 0.0171). The operating time was significantly shorter in the SLG group than in the MLG group (169 vs. 182min, p = 0.0399). Other surgical outcomes were comparable between the study groups. SLG was shown to be safe and feasible in the treatment of gastric cancer with better short-term results in terms of less severe pain and may be suitable for treatment of cStage I gastric cancer. UMIN000022218.

The Safety and Feasibility of Single-Port Laparoscopic Gastrectomy for Advanced Gastric Cancer

BackgroundSingle-port laparoscopic surgery maximizes the advantages of laparoscopic surgery by reducing damage of the abdominal wall. However, no comparative studies have addressed its application to gastrectomy for advanced gastric cancer (AGC). We therefore aimed to demonstrate the safety and feasibility of single-port laparoscopic gastrectomy (SLG) for the treatment of AGC by comparing it with conventional multi-port laparoscopic gastrectomy (MLG). MethodsWe searched the prospective gastric cancer database of our institute for patients with AGC who underwent SLG or MLG between October 2007 and December 2013. Cases of R2 resection with distant metastasis or concurrent surgery for comorbid malignant lesions were excluded. One-to-one propensity score matching was performed to reduce bias from confounding patient-related variables, and the short- and long-term outcomes were compared between the two groups. ResultsWe identified 216 patients who underwent SLG (n = 100) or MLG (n = 116). After propensity score matching, we selected 73 pairs of patients who underwent SLG (distal gastrectomy, 49; total gastrectomy, 24) or MLG (distal gastrectomy, 45; total gastrectomy, 28). While the mean operative times were comparable between the groups, the SLG group had less blood loss, a lower postoperative morbidity, and shorter postoperative hospital stays. The 5-year survival rates were 74.2% in the SLG group and 60.2% in the MLG group (P = 0.081 by log-rank test). ConclusionsSLG is shown to be safe and feasible for the treatment of AGC, with better short-term results and acceptable oncologic outcomes and may be applicable for AGC treatment.

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

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.