Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2020; 26(31): 4669-4679
Published online Aug 21, 2020. doi: 10.3748/wjg.v26.i31.4669
Initial experience of single-incision plus one port left-side approach totally laparoscopic distal gastrectomy with uncut Roux-en-Y reconstruction
Wei Zhou, Chang-Zheng Dong, Yi-Feng Zang, Ying Xue, Xing-Guo Zhou, Yu Wang, Yin-Lu Ding
Wei Zhou, Chang-Zheng Dong, Yi-Feng Zang, Ying Xue, Xing-Guo Zhou, Yu Wang, Yin-Lu Ding, Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
Author contributions: Zhou W, Dong C Z and Zang Y F designed the research and analyzed the data; Zhou W drafted the manuscript; Xue Y, Zhou X G and Wang Y collected the data; Zhou W and Ding Y L revised the paper; all authors read and approved the final version.
Supported by Key R& D Programs in Shandong China, No. 2019GSF10822; and Jinan Science & Technology Bureau, No. 201704125.
Institutional review board statement: The study was reviewed and approved by The Second Hospital, Cheeloo College of Medicine, Shandong University Institutional Review Board.
Conflict-of-interest statement: We declare that there are no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yin-Lu Ding, MD, Chief Doctor, Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, No. 247 Beiyuan Street, Jinan 250012, Shandong Province, China. dingyinlu@126.com
Received: April 19, 2020
Peer-review started: April 19, 2020
First decision: June 8, 2020
Revised: June 21, 2020
Accepted: July 23, 2020
Article in press: July 23, 2020
Published online: August 21, 2020
Processing time: 123 Days and 14 Hours
Abstract
BACKGROUND

Single 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.

AIM

To 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.

METHODS

A 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.

RESULTS

All 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.

CONCLUSION

SILS+1/L TLDG with uncut R-Y reconstruction could be safely performed as a reduced port surgery.

Keywords: Laparoscopy; Distal gastrectomy; Single-incision plus one port; Uncut Roux-en-Y gastrojejunostomy; Reduced port surgery; Gastric cancer

Core tip: Single-incision plus one port left-side approach totally laparoscopic distal gastrectomy has become increasingly popular to treat gastric cancer because of fewer ports and shorter length of incisions. However, there are no previous reports on the use of single-incision plus one port left-side approach totally laparoscopic distal gastrectomy with uncut Roux-en-Y reconstruction. We reported our initial experience and demonstrated that single-incision plus one port left-side approach totally laparoscopic distal gastrectomy with uncut Roux-en-Y reconstruction is safe and feasible.