Single-port laparoscopic subtotal gastrectomy with DIα lymphadenectomy

"Conventional multiport" laparoscopic gastrectomy for early stage gastric cancer is an increasingly frequently performed procedure. The authors describe their experience of the first reported single-port laparoscopic subtotal gastrectomy in an 88-year-old lady with early antral gastric adenocarcinoma.

Single-port laparoscopic subtotal gastrectomy with D1α lymphadenectomy was successfully performed using a transumbilical multichannel single port. Straight and flexible tipped laparoscopes were used to obtain off-axis views of the operative field. A flexible tipped stapler and curved instruments were used to reconstruct the Polya-type gastrojejunostomy. The procedure was performed without compromising standard, oncological principles.

Specimen histology revealed moderately to poorly differentiated adenocarcinoma infiltrating the submucosa. Proximal and distal resection margins were tumor free. Furthermore, 41 tumor-free lymph nodes were harvested. The patient was discharged on postoperative day 6.

Single-port gastrectomy for cancer is technically and oncologically feasible when performed by experienced minimally invasive surgical oncologists with extensive experience of benign single-port laparoscopic procedures. The advantages to the patient in terms of cosmesis and shorter hospital stay are clear. However, further studies are required to assess this technique when treating gastric and other malignancies.