Laparoscopically assisted distal partial gastrectomy for early-stage gastric carcinomas

Endoscopic mucosal resection (EMR) is now in clinical use for the management of small, early-stage gastric, carcinomas, although some patients are treated via laparotomy when the lesions are not suitable for, EMR due to their size, depth, and location. In many cases of invasive mucosal carcinoma with submucosal involvement, the regional lymph nodes along with the distal portion of the stomach must also be resected. In order to remove the whole resected specimen, a mini-laparotomy of appropriate length (5 cm) is performed which can be located at the optical port site after removing the laparoscope. By applying an abdominal wall elevator through the mini-laparotomy, direct vision is possible which facilitates resection of the regional lymph nodes and intestinal anastomosis. We describe our technique for laparoscopically assisted distal gastrectomy and present our early clinical results.