Bruno Zilberstein, MD, PHD, FACS, Leandro Barchi, MD, PHD, Maurice Youssef, MD, Thiago Manesco, MD, Willy Petrini Souza, MD. Gastromed
Laparoscopic surgery has been increasingly applied to gastric cancer surgery. Gastrointestinal tract reconstruction totally done by laparoscopy also has been a challenge for those who developed this procedure. After introduction of laparoscopic stapling methods, the reconstruction techniques became more feasible.
The gastrectomy began with the mobilization of the greater curvature along the transverse colon, carried out with ultrasonic shears. The roots of the right gastroepiploic and gastric vessels were exposed by delicate dissection. Located a endoscopic linear stapler for the duodenal transection. Routinely, the reinforcement of the linear stapler was done with separated or continuous seromuscular suture. After, the dissection of the right gastric (pyloric) vessels was performed dividing them with clips and removing 12a LN station, then going through the common hepatic artery with the 8a LN station removal.
After completion of lymph node dissection, the esophagus was transected with a linear stapler with white cartridge, finishing the gastric resection. Continuity of digestive tract was performed with a Roux- en-Y diversion. To facilitate this maneuver, the duodenojejunal angle was identified and a jejunal loop about 30-40 cm away was transposed to the supramesocolic space using transmesocolic. The jejunal loop was anchored by a stitch to the left lateral wall of the abdominal transected esophagus . A 12 French bougie was orally introduced by the anesthesiologist to better expose the esophageal stump. A linear stapler with white cartridge was utilized to perform the laterolateral esophagojejunal anastomosis .
Next, the alimentary limb was isolated with about 70 cm long and also brought in the upper abdomen, close to the biliary limb in order to perform the jejunojejunal anastomosis of the Roux-en-Y reconstruction. This anastomosis was also performed with a 45 mm white cartridge linear stapler closing the stapler entrance by hand sewn with extramucosal 3-0 PDS®. Finished all the anastomosis, the closures were tested instilling by the esophageal bougie diluted methylene blue solution to ensure the good closure of the anastomosis. Once tested, the biliary limb and the alimentary limb were divided and separated by linear stapler with 45 mm white cartridge. In the transmesocolic route, the alimentary limb was tractioned and the enteroenteric anastomosis located in the inframesocolic space. The mesenteric gap was closed with manual interrupted suture.
The Objective of this report is to show an step by step procedure and show the application of videolaparoscopic oncological total gastrectomy, when the right steps are followed, can be performed safely.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95450
Program Number: V132
Presentation Session: Solid Organ Videos
Presentation Type: Video