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KMID : 0371320010610020211
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Journal of the Korean Surgical Society
2001 Volume.61 No. 2 p.211 ~ p.215
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Hand-assisted Laparoscopic Total Gastrectomy
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Kim Young-Woo
Yi Nam-Joon
Han Ho-Seong
Choi Yong-Man
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Abstract
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Although the standard treatment of gastric cancer is still radical subtotal or total gatrectomy, minimal invasive surgery is a primary issue in early gastric cancer, because quality of life is very important if the disease is curable.
Laparoscopic
total
gastrectomy has not yet met widspread acceptance owing to the technical difficulties and has not been reported in Korea. The authors used the Handport systemTM, which enables introducing one of the surgeon’s hands into the abdominal
cavity
while maintaining pneumoperitoneum. The patient was a 38-year old man. His chief complaint was hematemesis. Emergency esophagogatroscopy revealed cardiac ulcer with active bleeding. Sclerotherapy was successfully done and the patient was
stabilized.
Follow-up gastroscopic examination and biopsy demonstrated moderately differentiated adenocarcinoma in the ulcer area. The surgery was done electively. The operator’s left hand was inserted into the abdomen through the right upper quadrant via
the
Handport system. An additional 10 mm working port was made in the left upper quadrant. Laparoscopy was inserted through the umbilical port. An Ultrashear was used for dissection of omentum and perigastric vessels. D1 plus alpha lymph node
dissection
was performed completely. Roux-en-Y esophagojejunostomy was done for reconstruction through the Handport site. Opeation time was 6 hours and blood loss was 500 ml. No transfusion was required. The patient recovered uneventfully and was discharged
at 16
postoperative days. In terms of recovery and quality of life laparoscopic total gastrectomy is a technically feasible and reasonable option for the treatmentof early gastric cancer.
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