Laparoscopic gastrectomy for heart failure patients with left ventricular assist devices

Left ventricular assist devices (LVADs) currently play an important role in the treatment of patients with end-stage heart failure who require a bridge to heart transplantation. As the LVAD population increases, the incidence of cancer patients with an LVAD is assumed to be increasing as well. For gastric cancer patients with an LVAD, surgery may be the only curative treatment, especially as chemotherapy is scarcely available. However, we cannot perform an upper-middle incision in these patients because of the LVAD's location and driveline. Furthermore, to reduce the risk of driveline infection, minimally invasive surgery is desirable. Therefore, laparoscopic surgery is, where possible, suitable for achieving a secure approach to the abdominal cavity. However, laparoscopic surgery for patients with LVAD requires careful consideration not only for anesthetic management, but also for the technical procedure. We ingenuously performed laparoscopic gastrectomy for a gastric cancer patient with LVAD to preserve the device and obtain a good surgical view.