Multi-Vector Retraction Using Extracorporeally Suspended Retractor in Single Port Total Gastrectomy

Single-incision laparoscopic surgery (SILS) and needle forceps have been introduced to enhance cosmetic outcomes and reduce postoperative pain. However, in demanding procedures like total gastrectomy, these approaches can be technically challenging due to limited triangulation and lack of assistant support. We report the case of a 31-year-old woman with gastric cancer who requested a cosmetically favorable procedure. A total gastrectomy with D2 lymphadenectomy was performed using a SILS approach with one 3-mm needle forceps. To maintain adequate exposure without an assistant port, we utilized an adjustable organ retractor that allows multidirectional traction by repositioning external sutures. This technique provided stable visualization and facilitated a safe, oncologically appropriate dissection. The patient was discharged uneventfully without major complications and remains recurrence-free at 3 years. We report a technical modification that enabled the safe performance of SILS total gastrectomy using a needle forceps in combination with an adjustable organ retractor.