• Journal of Gastric Cancer
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• 제13권3호
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• pp.188-191
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• 2013

As the incidence of early gastric cancer increases, laparoscopic surgery has become one of the treatments of choice for gastric cancer. With the increase of laparoscopic surgery, the chance of discovering aberrant anatomy during the operation also increases. We present a case of laparoscopic total gastrectomy in gastric cancer patients with intestinal malrotation. Intestinal malrotation occurs in one in every 500 births. We found that laparoscopic total gastrectomy in such patients can be performed successfully when it is performed with a proper Roux limb orientation through an alternative minilaparotomy.

• Journal of Gastric Cancer
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• 제13권1호
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• pp.19-25
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• 2013

Laparoscopic gastrectomy has been widely accepted especially in patients with early-stage gastric cancer. However, the safety and oncologic validity of laparoscopic gastrectomy for advanced gastric cancer are still being debated. Since the late 90s', we have been engaged in developing a stable and robust methodology of laparoscopic radical gastrectomy for advanced gastric cancer, and have established laparoscopic distinctive technique for suprapancreatic lymph node dissection, namely the outermost layer-oriented medial approach. In this article, We present the development history of this method, and current status and future perspectives of laparoscopic gastrectomy for advanced gastric cancer based on our experience and a review of the literature.

• Journal of Gastric Cancer
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• 제10권4호
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• pp.188-195
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• 2010

Purpose: This study was done to evaluate the usefulness of preoperative computed tomography (CT) and intraoperative laparoscopic ultrasound to facilitate treatment of gastric submucosal tumors. Materials and Methods: The feasibility of laparoscopic wedge resection as determined by CT findings of tumor size, location, and growth pattern was correlated with surgical findings in 89 consecutive operations. The role of laparoscopic ultrasound for tumor localization was analyzed. Results: Twenty-three patients were considered unsuitable for laparoscopic wedge resection because of large tumor size (N=13) or involvement of the gastroesophageal junction (N=9) or pyloric channel (N=1). Laparoscopic wedge resection was not attempted in 11 of these patients because of large tumor size. Laparoscopic wedge resection was successfully performed in 65 of 66 (98.5%) patients considered suitable for this procedure. Incorrect interpretation of preoperative CT resulted in a change of surgery type in seven patients (7.9%): incorrect CT diagnosis on gastroesophageal junction involvement (N=6) and on growth pattern (N=1). In 18 patients without an exophytic growth pattern, laparoscopic ultrasound was necessary and successfully localized all lesions. Conclusions: Preoperative CT and laparoscopic ultrasound are useful for surgical planning and tumor localization in laparoscopic wedge resection.

• Journal of Gastric Cancer
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• 제11권4호
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• pp.230-233
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• 2011

Regarding the removal of a gastric bezoar, laparoscopic surgery was performed and it was shown that the laparoscopic approach is safe and feasible. However, the laparoscopic method has the risk of intraabdominal contamination, when the gastric bezoar is retrieved from the gastric lumen in the peritoneal cavity. We developed and applied a new procedure for the removal of the gastric bezoar using one surgical glove and two wound retractors as a fashion of intragastric single port surgery. Herein we present this new minimal invasive procedure, so named "hybrid access surgery" which involves the use of existing devices and overcomes the weakness of laparoscopic removal of the gastric bezoar. Our new procedure, combining the concept of intragastric and single port access, is acceptable and feasible to retrieve the gastric bezoar. In the future, this procedure may be one of the alternative procedures for retrieving gastric bezoar even when it is incarcerated in the pylorus.

• Journal of Gastric Cancer
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• 제12권3호
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• pp.133-139
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• 2012

Laparoscopic gastrectomy has become widely used as a minimally invasive technique for the treatment of gastric cancer. When it was first introduced, most surgeons preferred a laparoscopic-assisted approach with a minilaparotomy rather than a totally laparoscopic procedure because of the technical challenges of achieving an intracorporeal anastomosis. Recently, with improved skills and instruments, several surgeons have reported the safety and feasibility of a totally laparoscopic gastrectomy with intracorporeal anastomosis. This review describes the recent technical advances in intracorporeal anastomoses using circular and linear staplers that allow for totally laparoscopic distal, total, and proximal gastrectomies. Data that demonstrate advantages in early surgical outcomes of a total laparoscopic method compared to laparoscopic-assisted operations are also discussed.

• Journal of Gastric Cancer
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• 제10권3호
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• pp.133-136
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• 2010

Purpose: The aim of this study was to evaluate the effectiveness of our retraction method for achieving a good operative field for the adequate lymph node dissection during laparoscopic gastrectomy in view of short term surgical outcome. Materials and Methods: This study prospectively enrolled 19 patients who underwent laparoscopic gastrectomy for early gastric cancer. The procedure was simply performed by putting the laparoscopic sigle suture in the phrenoesophageal ligament, and then the string was pulling and tying over the sternum. Surgical outcomes of these patients were evaluated. Results: Under V-shaped liver retraction, the mean operating time and mean number of retrieved lymph nodes was 166.3 minute and 31.37, respectively. And the results were satisfactory compared to open or conventional laparoscopic gastric surgery. Conclusions: V-shaped liver retraction requires no extra port or assistant's hands, and prevents additional injury to any intra-abdominal organ. And this method can easily, efficiently and safely enable to achieve a good operative field for the lymph node dissection near the lesser curvature of the stomach.

• Journal of Gastric Cancer
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• 제4권2호
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• pp.75-81
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• 2004

Recently detection of early gastric cancer (EGC) has been increasing and the treatment strategies for gastric cancer have been changing. The purpose of this study was to compare clinical outcomes between laparoscopically assisted (LADG) and hand-assisted laparoscopic gastrectomy (HALDG) and open distal gastrectomy for early gastric cancer. This review is directed toward providing gastric surgeons with recent advances in the treatment of EGC. We investigated the English language literature for the past 12 years through computer searches which focused on : 1) Patient demographics, 2) Operation time, 3) Intra-operative blood loss, 4) Depth of invasion, 5) CBC, 6)Weight loss, 7) Analgesic requirement, 8)Time NPO, 9) Length of hospital stay, 10) Tumor stage, 11) Lymph node (LN) dissection, 12) Position of LN resected, 13) Complications. Improved operative techniques and surgical instrumentation have facilitated the development of minimally invasive gastric cancer surgery. The short-term benefits of laparoscopic gastrectomy included less surgical trauma, less pain, rapid return of gastrointestinal function, and shorter hospital stay, with no change in operative outcome. Laparoscopic gastrectomy was better accepted by the patients as a good procedure and promptly brought the patients back to their previous lifestyle and activities of daily living. But the advantages of HALDG for gastric cancer, extended lymph node dissection and intracorporeal anastomosis are feasible and easier with the presence of the internal hand. The hand-assisted laparoscopic (HALDG) method reported the best results in lymph node dissection.This method is an alternative to total laparoscopic radical gastrectomy. LADG and HALDG, when compared with conventional open gastrectomy, have several advantages. When performed by a skilled surgeon, LADG and HALDG are safe and useful techniques for patients with early-stage gastric cancer. Their appropriateness for gastric cancer surgery require further study.

• Journal of Gastric Cancer
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• 제15권4호
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• pp.286-289
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• 2015

It is well known that gastrectomy with curative intent is the best way to improve outcomes of patients with remnant gastric cancer. Recently, several investigators reported their experiences with laparoscopic gastrectomy of remnant gastric cancer. We report the case of an 83-year-old female patient who was diagnosed with remnant gastric cancer with obstruction. She underwent an entirely laparoscopic distal gastrectomy with colectomy because of direct invasion of the transverse colon. The operation time was 200 minutes. There were no postoperative complications. The pathologic stage was T4b (transverse colon) N0M0. Our experience suggests that laparoscopic surgery could be an effective method to improve the surgical outcomes of remnant gastric cancer patients.

• Journal of Gastric Cancer
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• 제19권2호
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• pp.157-164
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• 2019

Purpose: Although standard radical gastrectomy is recommended after noncurative resection of endoscopic submucosal dissection (ESD) for early gastric cancer in most cases, residual tumor and lymph node metastasis have not been identified after surgery. The aim of this study is to evaluate the feasibility of sentinel node navigation surgery after noncurative ESD. Materials and Methods: This trial is an investigator-initiated, multicenter prospective phase II trial. Patients who underwent ESD for clinical stage T1N0M0 gastric cancer with noncurative resections were eligible. Qualified investigators who completed the prior phase III trial (SENORITA 1) are exclusively allowed to participate. In this study, 2 detection methods will be used: 1) intraoperative endoscopic submucosal injection of dual tracer, including radioisotope and indocyanine green (ICG) with sentinel basins detected using gamma-probe; 2) endoscopic injection of ICG, with sentinel basins detected using a fluorescence imaging system. Standard laparoscopic gastrectomy with lymphadenectomy will be performed. Sample size is calculated based on the inferior confidence interval of the detection rate of 95%, and the calculated accrual is 237 patients. The primary endpoint is detection rate, and the secondary endpoints are sensitivity and postoperative complications. Conclusions: This study is expected to clarify the feasibility of laparoscopic sentinel basin dissection after noncurative ESD. If the feasibility is demonstrated, a multicenter phase III trial will be initiated to compare laparoscopic sentinel node navigation surgery versus laparoscopic standard gastrectomy in early gastric cancer after endoscopic resection.

• Journal of Gastric Cancer
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• 제19권4호
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• pp.484-492
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• 2019

Few surgeons have adopted pancreaticoduodenectomy (PD) for the treatment of advanced gastric cancer (AGC) invading the pancreas or duodenum because it remains controversial whether its prognostic benefits outweigh the high morbidity rates in such advanced cases. However, recent technical advances have revived diverse surgical procedures in minimally invasive approaches. Inspired by this trend, laparoscopic PD procedures have been performed for AGC in our institute since 2014. We recently performed a laparoscopic Whipple's operation in a case of cT4b gastric cancer with invasion of the pancreatic head and duodenum.