|SSAT “How I Do It” Series: Gastric Cancer
The 2014 "How I Do It" Video Series features gastric cancer surgeries from Argentina, China, Germany, Japan and Korea. Prof Ernst J. M. Klar, MD, SSAT International Relations Committee Chair, introduces the series in the first video, followed by surgical videos, and finally summarized by International Relations Committee Member Jiping Wang, MD, PHD.
This video shows the steps of a laparoscopic subtotal and total gastrectomy with D2 lymphadenectomy. First, the gastrocolic ligament is divided. Then right gastroepiploic and right gastric vessels (along with nodes groups 6-5) are dissected. The duodenum is transected using an endoscopic linear stapler. Lymphadenectomy of groups 8a and 11p is performed, and left gastric vein and artery are divided along with groups 7-9. Resection of groups 1-3 is completed. For a total gastrectomy dissection continues through the greater curvature. Finally, end to side reconstruction is showed with Roux-en-Y esophagojejunostomy for total gastrectomy.and a Billroth II technique for subtotal gastrectomy.
Assistant's traction of the mesocolon downward is very important to facilitate dissection along the fusion of embryologic plain between mesocolon and greater omentum. The Mesocolic vessel can be a good indicator for finding embryologic plain. When doing the Rt. side of partial omentectomy, we have to be careful to avoid injury to the mesocolic vessel or transverse colon, especially hepatic flexure. Saving the Rt. gastroepiploic vein and the Rt. gastroepiploic artery is very important. Dissection along the arcade of lesser curvature should start at least 3 cm from the pylorus. To preserve pyloric function the operator should try not to injure the hepatic branch of the vagus nerve.
The video highlights the lymphadenectomy along the splenic artery and the splenic hilum in a D2 total gastrectomy. Following the omento-bursectomy procedure, the pancreatic body and the spleen are totally mobilized. This can be completed without bleeding by precisely entering the space between the retropancreatic fascia and the Toldt fusion fascia. The splenic artery is dissected right after the great pancreatic artery branches, while the splenic vein is preserved all along the pancreas. The lymph nodes and possible tumor dissemination in the splenic hilum are removed en block by this procedure.
The patient is a 56-year-old female and under went gastroscopy, endoscopic ultrasound and abdominal enhanced CT after admission. The tumor was found in antral lesser curvature and pathological diagnosis was poorly differentiated adenocarcinoma. The clinical TNM stage of the tumor was cT1bN0M0. Electric hook was applied almost during operation in order to follow sharp dissection and "no touch" principle. For better hemostasis, controlled hypertension was recommended and mean arterial pressure was maintained about 70mmHg. After dissection and resection, the median incision was performed on the upper abdomen, and the reconstruction was carried out with Billroth I by CDH stapler?
This video describes a gastrectomy for gastric adenocarcinoma at the front wall of the stomach. The location is clearly outlined in the video. The first step includes gastric resection with the adjacent D1-lymphnodes. Then D2-lymphadenectomy is added starting from the hepatoduodenal ligament. The reconstruction is performed by a Roux en-Y loop as end- to- side esophago-jejunostomy by a single stich hand-sewn anastomosis. The final anastomosis is performed in a similar fashion as end-to-side jejuno-jejunostomy.
This video describes a gastrectomy for gastric adenocarcinoma at the front wall of the stomach. The location is clearly outlined in the video. The first step includes gastric resection with the adjacent D1-lymphnodes. Then D2-lymphadenectomy is added starting from the hepatoduodenal ligament. The reconstruction is performed by a Roux en-Y loop as end-to-side esophago-jejunostomy by a single stich hand-sewn anastomosis. The final anastomosis is performed in a similar fashion as end-to-side jejuno-jejunostomy.
|About the SSAT|
|Pay Membership Dues|
|Meetings & Education|
|Patient Care Guidelines|