Related Experiment Video
Updated: May 17, 2026
03:32
Single Incision Plus One Port Laparoscopic Proximal Gastrectomy with Double Channel Anastomosis for Gastric Cancer Treatment
Published on: December 27, 2024
Totally laparoscopic total gastrectomy using endoscopic linear stapler: early experiences at one institute
Hee Sung Kim1, Min Gyu Kim, Beom Su Kim
1Department of Gastric Surgery, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea.
Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
|November 10, 2012
Summary
Totally laparoscopic total gastrectomy (TLTG) is challenging due to intracorporeal esophagojejunostomy. A new technique using endoscopic linear staplers improved outcomes, reducing complications and operation time significantly.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Totally laparoscopic total gastrectomy (TLTG) for gastric cancer remains uncommon due to technical challenges, particularly laparoscopic esophagojejunostomy.
- A novel technique for secure intracorporeal esophagojejunostomy using an endoscopic linear stapler has been developed.
- This study reports the initial experiences and outcomes of performing TLTG with this technique.
Purpose of the Study:
- To evaluate the feasibility and safety of a newly developed technique for intracorporeal esophagojejunostomy during TLTG.
- To assess the learning curve and identify technical improvements for TLTG using endoscopic linear staplers.
- To compare surgical outcomes between early and later cases of TLTG.
Main Methods:
- A retrospective review of 124 patients with gastric cancer who underwent TLTG using endoscopic linear staplers between July 2009 and May 2010.
- Clinicopathological data and surgical outcomes were analyzed, comparing the first 70 cases with the subsequent 54 cases.
- Technical improvements were instituted after the 70th case, and their impact on outcomes was assessed.
Main Results:
- Significant differences were observed between the early and later groups in mean operation time (189.0 vs. 148.3 minutes, P<.001).
- Postoperative complication rates were significantly lower in the later group (overall: 13.0% vs. 37.1%, P=.003; severe: 3.7% vs. 15.7%, P=.030).
- Intraoperative event rates also decreased significantly in the later group (1.9% vs. 12.9%, P=.042).
Conclusions:
- The initial phase of TLTG using endoscopic linear staplers was associated with a high morbidity rate.
- Key technical modifications led to significant improvements in surgical outcomes and reduced complication rates.
- Surgeons new to laparoscopic gastrectomy should exercise caution with TLTG; this experience may facilitate safer and faster adoption of the technique.
