Reduced port laparoscopic gastrectomy: a review, techniques, and perspective

Influence of reduced-port laparoscopic surgery on perioperative indicators, postoperative recovery, and serum inflammation in patients with colorectal carcinoma

BACKGROUND

Conventional five-port laparoscopic surgery, the current standard treatment for colorectal carcinoma (CRC), has many disadvantages.

AIM

To assess the influence of reduced-port laparoscopic surgery (RPLS) on perioperative indicators, postoperative recovery, and serum inflammation indexes in patients with CRC.

METHODS

The study included 115 patients with CRC admitted between December 2019 and May 2023, 52 of whom underwent conventional five-port laparoscopic surgery (control group) and 63 of whom underwent RPLS (research group). Comparative analyses were performed on the following dimensions: Perioperative indicators [operation time (OT), incision length, intraoperative blood loss (IBL), and rate of conversion to laparotomy], postoperative recovery (first postoperative exhaust, bowel movement and oral food intake, and bowel sound recovery time), serum inflammation indexes [high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6)], postoperative complications (anastomotic leakage, incisional infection, bleeding, ileus), and therapeutic efficacy.

RESULTS

The two groups had comparable OTs and IBL volumes. However, the research group had a smaller incision length; lower rates of conversion to laparotomy and postoperative total complication; and shorter time of first postoperative exhaust, bowel movement, oral food intake, and bowel sound recovery; all of which were significant. Furthermore, hs-CRP, IL-6, and TNF-α levels in the research group were significantly lower than the baseline and those of the control group, and the total effective rate was higher.

CONCLUSION

RPLS exhibited significant therapeutic efficacy in CRC, resulting in a shorter incision length and a lower conversion rate to laparotomy, while also promoting postoperative recovery, effectively inhibiting the inflammatory response, and reducing the risk of postoperative complications.

Needle device-assisted single-incision laparoscopic gastrectomy for early gastric cancer: A propensity score-matched analysis

INTRODUCTION

Single-incision laparoscopic gastrectomy can be difficult because of complex instrumentation and a limited working angle. We standardized a needle device-assisted single-incision laparoscopic gastrectomy (NA-SILG) procedure for early gastric cancer in 2013. Herein, we present our technique and evaluate it in comparison to the conventional laparoscopic gastrectomy CLG) technique.

METHODS

We retrospectively reviewed medical records of 149 patients who underwent a NA-SILG or distal (CLG) for early gastric cancer between January 2013 and August 2016. We performed 1:1 propensity score matching between the two groups.

RESULTS

Eighteen patients who underwent a NA-SILG and 131 who underwent a CLG were included. Almost all patients were in clinical stage IA. Operative times were 216 ± 29.7 minutes and 220 ± 51.7 minutes for the NA-SILG and CLG groups, respectively; the median intraoperative bleeding amounts were 5 mL and 10 mL for the NA-SILG and CLG groups, respectively. The median number of retrieved lymph nodes was 41.5 and 57 for the NA-SILG and CLG groups, respectively. The number of patients needing analgesics was significantly lower in the NA-SILG group (P = .003) than in the CLG group. Neither group had postoperative complications more severe than Clavien-Dindo classification III.

CONCLUSION

Needle device-assisted SILG is safe and feasible for early gastric cancer treatment in slim figure patients. It has short and long-term outcomes comparable to the CLG but is less invasive and results in less postoperative pain.

Evaluation of Reduced Port Laparoscopic Distal Gastrectomy Performed by a Novice Surgeon

Purpose

Reduced port laparoscopic distal gastrectomy (RPLDG) using 3 ports is less invasive than conventional laparoscopic distal gastrectomy (CLDG) using 5 ports. Although RPLDG performed by expert surgeons is safe and feasible, novice surgeons have difficulty performing this procedure. This study evaluated the surgical outcomes and feasibility of RPLDG performed by a novice surgeon.

Materials and Methods

The records of 136 patients who underwent laparoscopic distal gastrectomy for gastric cancer performed by a single novice surgeon between May 2016 and December 2018 were retrospectively reviewed. Among these 136 patients, 52 underwent RPLDG and 84 underwent CLDG. The clinicopathological characteristics, operative outcomes, and short-term postoperative outcomes of the 2 groups were compared.

Results

The percentage of women was significantly higher in the RPLDG group than in the CLDG group (48.1% vs. 31%; P=0.045), but other baseline characteristics did not differ significantly between the groups. Billroth II anastomosis was performed significantly more frequent (90.4% vs. 73.8%, P=0.015) and operation time was significantly shorter (207.1±43.3 min vs. 225.5±44.6 min, P=0.020) in the RPLDG group than in the CLDG group. The time to first flatus, postoperative pain score, length of postoperative hospital stay, and incidence and severity of complications did not differ significantly between the groups. Analysis of the learning curve based on the operation time showed that performing RPLDG on 20-30 patients was required to achieve technical proficiency.

Conclusions

RPLDG is a safe and feasible surgical procedure for the treatment of gastric cancer, even when performed by a novice surgeon.

Experimental evaluation of the fineness of needle forceps: advantages other than minimal access

PURPOSE

Needle forceps are used to limit damage to the abdominal wall in endoscopic surgery; however, few experimental studies have evaluated the fineness and performance of needle forceps. We conducted this study to identify the advantages of needle forceps over conventional 5 mm forceps, focusing on fine grasping and needle control.

METHODS

Twenty physicians executed tasks using 5 mm forceps and 2.1 mm small diameter forceps in a laparoscopic experimental setting. First, we timed the execution and recorded the number of drops in a task of grasping and moving grains of rice and red beans. Next, we measured the execution time, looseness of the knot, and the deviation from the stitching point in a suture and ligation task using suture needles with a diameter of 17 or 26 mm.

RESULTS

The needle forceps required a significantly shorter execution time to move the rice grains (37.7 s vs. 45.8 s; p = 0.01) and a significantly higher completion rate (90% vs 20%; p < 0.01). The deviation of the stitching point using the 17 mm needle with needle forceps was significantly smaller than with the 5 mm forceps (0.5 mm vs. 1.0 mm; p < 0.01).

CONCLUSION

Needle forceps are better for procedures requiring fine grasping and enable more accurate small diameter needle control than 5 mm forceps.

Is the 5-port approach necessary in laparoscopic gastrectomy? Comparison of surgical effects of reduced-port laparoscopic gastrectomy and conventional laparoscopic-assisted gastrectomy: A meta-analysis

BACKGROUND

Reduced-port surgery, in which fewer ports are used than those in conventional laparoscopic surgery, is becoming increasingly popular for various procedures. However, the application of reduced-port surgery to the gastrectomy field is still underdeveloped. The aim of this study was to use meta-analysis to address the potentially important advantages of this surgical technique.

METHODS

Embase, PubMed, and Cochrane Library databases were systematically reviewed (through October 2019) to identify studies that compared reduced-port (RPLG) and conventional laparoscopic-assisted gastrectomy (CLG) in patients with gastric carcinoma. The endpoints were postoperative time, length of in-hospital stay, blood loss, retrieved lymph nodes, postoperative complications, time to first flatus, and aesthetic outcome.

RESULTS

A total of 11 studies, which included 1743 patients (907 RPLG and 836 CLG), were ultimately included in this analysis. Better aesthetic results: were obtained with RPLG (risk ratio 1.578; 95%CI, 1.377-1.808; P = .000), although length of in-hospital stay (standard mean difference [SMD] -0.106; 95% CI, -0.222 to 0.010; P = .074), time to first flatus (SMD -0.006; 95%CI, -0.123 to 0.110; P = .913), and perioperative complications (risk ratio 0.255; 95%CI, 0.142-0.369; P = .478) were equivalent. However, operative time was significantly longer (SMD 0.301; 95%CI, 0.194-0.409; P = .00), blood loss was greater (SMD -0.31; 95%CI, -0.415 to 0.205; P = .000), and fewer lymph nodes were harvested (SMD 0.255; 95%CI, 0.142-0.369; P = .000) in the RPLG group.

CONCLUSIONS

Our meta-analysis showed that RPLG is as safe as the CLG approach and offers better aesthetic results for patients with gastric carcinoma. However, basing on current evidence, RPLG was not an efficacious surgical alternative to CLG, as operative time was significantly longer, blood loss was greater, and fewer lymph nodes were harvested in the RPLG group. Additional high-powered controlled randomized trials are required, to determine whether RPLG truly offers any advantages; these future studies should particularly focus on pain scores and aesthetic outcomes.

Reduced-port totally robotic distal subtotal gastrectomy for gastric cancer: 100 consecutive cases in comparison with conventional robotic and laparoscopic distal subtotal gastrectomy

By overcoming technical difficulties with limited access faced when performing reduced-port surgery for gastric cancer, reduced-port totally robotic gastrectomy (RPRDG) could be a safe alternative to conventional minimally invasive gastrectomy. An initial 100 consecutive cases of RPRDG for gastric cancer were performed from February 2016 to September 2018. Short-term outcomes for RPRDG with those for 261 conventional laparoscopic (CLDG) and for 241 robotic procedures (CRDG) over the same period were compared. Learning curve analysis for RPRDG was conducted to determine whether this procedure could be readily performed despite fewer access. During the first 100 cases of RPRDG, no surgeries were converted to open or laparoscopic surgery, and no additional ports were required. RPRDG showed longer operation time than CLDG (188.4 min vs. 166.2 min, p < 0.001) and similar operation time with CRDG (183.1 min, p = 0.315). The blood loss was 35.4 ml for RPRDG, 85.2 ml for CLDG (p < 0.001), and 41.2 ml for CRDG (p = 0.33). The numbers of retrieved lymph nodes were 50.5 for RPRDG, 43.9 for CLDG (p = 0.003), and 55.0 for CRDG (p = 0.055). Postoperative maximum C-reactive protein levels were 96.8 mg/L for RPRDG, 87.8 mg/L for CLDG (p = 0.454), and 81.9 mg/L for CRDG (p = 0.027). Learning curve analysis indicated that the overall operation time of RPRDG stabilized at 180 min after 21 cases. The incidence of major postoperative complications did not differ among groups. RPRDG for gastric cancer is a feasible and safe alternative to conventional minimally invasive surgery. Notwithstanding, this procedure failed to reduce postoperative inflammatory responses.

Initial experience of single-incision plus one port left-side approach totally laparoscopic distal gastrectomy with uncut Roux-en-Y reconstruction

BACKGROUND

Single incision plus one port left-side approach (SILS+1/L) totally laparoscopic distal gastrectomy (TLDG) is an emerging technique for the treatment of gastric cancer. Reduced port laparoscopic gastrectomy has a number of potential advantages for patients compared with conventional laparoscopic gastrectomy: relieving postoperative pain, shortening hospital stay and offering a better cosmetic outcome. Nevertheless, there are no previous reports on the use of SILS+1/L TLDG with uncut Roux-en-Y (uncut R-Y) reconstruction.

AIM

To investigate the initial feasibility of SILS+1/L TLDG with uncut Roux-en-Y digestive tract reconstruction (uncut R-Y reconstruction) to treat distal gastric cancer.

METHODS

A total of 21 patients who underwent SILS+1/L TLDG with uncut R-Y reconstruction for gastric cancer were enrolled. All patients were treated at The Second Hospital of Shandong University. Reconstructions were performed intracorporeally with 60 mm endoscopic linear stapler and 45 mm no-knife stapler. The clinicopathological characteristics, surgical details, postoperative short-term outcomes, postoperative follow-up upper gastrointestinal radiography findings and endoscopy results were analyzed retrospectively.

RESULTS

All SILS+1/L operations were performed by SILS+1/L TLDG successfully. The patient population included 13 men and 8 women with a mean age of 48.2 years (ranged from 40 years to 70 years) and median body mass index of 22.8 kg/m². There were no conversions to open laparotomy, and no other port was placed. The mean operation time was 146 min (ranged 130-180 min), and the estimated mean blood loss was 54 mL (ranged 20-110 mL). The mean duration to flatus and discharge was 2.3 (ranged 1-3.5) and 7.3 (ranged 6-9) d, respectively. The mean number of retrieved lymph nodes was 42 (ranged 30-47). Two patients experienced mild postoperative complications, including surgical site infection (wound at the navel incision) and mild postoperative pancreatic fistula (grade A). Follow-up upper gastrointestinal radiography and endoscopy were carried out at 3 mo postoperatively. No patients experienced moderate or severe food stasis, alkaline gastritis or bile reflux during the follow-up period. No recanalization of the biliopancreatic limb was found.

CONCLUSION

SILS+1/L TLDG with uncut R-Y reconstruction could be safely performed as a reduced port surgery.

Lymphadenectomy using two instrument arms during robotic surgery for gastric cancer: A strategy to facilitate reduced-port robotic gastrectomy

BACKGROUND

Three instrument arms are used in the current form of reduced-port robotic gastrectomy (RPRG) for gastric cancer. Based on our experience in performing reduced-port laparoscopic gastrectomy (RPLG), we have recently performed RPRG using two instrument arms.

METHODS

From February 2018 to January 2019, we performed RPRG using two instrument arms for gastric cancer. One endoscope arm and two instrument arms of da Vinci® Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) were applied in robotic lymphadenectomy. A commercial multi-lumen single-port trocar was used for the endoscopy port.

RESULTS

A total of 18 patients underwent the planned robotic surgery using two instrument arms. Median operation time was 288.5 (213.0-446.0) minutes, and median hospital stay was 11.0 (7-18) days. Four patients experienced postoperative complications: one Clavien-Dindo grade IIIa, and the other three grade II. No mortality was reported. The number of retrieved lymph nodes did not differ between patients who underwent RPRG and RPLG (p = 0.412).

CONCLUSION

Gastric cancer surgery using two instrument arms of a robotic surgical system can be performed by surgeons with expertise of RPLG. If this technique is successfully introduced in robotic surgery, it is expected to shorten the path to pure single-port robotic gastrectomy.

Initial Experience of Dual-Port Laparoscopic Distal Gastrectomy for Gastric Cancer: A Single-Arm Study

INTRODUCTION

Dual-port laparoscopic gastrectomy (DPLG) has been widely performed in recent years for treating gastric cancers. The present study reports our initial experience of dual-port laparoscopic distal gastrectomy (DPLDG).

METHODS

From November 2016 to August 2018, 38 consecutive patients underwent DPLDG in our center. The observational outcomes included 30-day morbidity and mortality rates, time to first flatus, time to first oral liquid diet, time to first oral semiliquid diet, time to drainage tube removal, visual analogue scale (VAS) score, postoperative 4-day recovery rate, additional analgesic use, hospital stay and cosmetic benefits.

RESULTS

Mean operative time was 191.6 ± 44.4 min, mean intra-operative blood loss was 39.8 ± 48.7 ml, and the mean number of dissected lymph nodes was 38.3 ± 13.7 nodes. One case was converted to five-port laparoscopic surgery, and no intraoperative complications occurred in any of the cases. The mean time to postoperative first flatus was 45.3 ± 18.0 h. The mean time to intake of an oral liquid diet was 56.7 ± 30.4 h. The mean time to drainage tube removal was 97.9 ± 52.3 h. The mean VAS scores for the 3 days after surgery were 2.3 ± 0.7, 2.0 ± 0.6 and 1.6 ± 0.5, respectively. A total of 81.6% of the enrolled patients met the postoperative 4-day recovery standard, and 15.8% of patients received additional analgesics. The mean postoperative hospital stay was 6.0 ± 2.0 days. No deaths were observed, and the 30-day morbidity rate was 13.2%.

CONCLUSION

DPLDG is a feasible and safe procedure for experienced surgeons with acceptable short-term outcomes, reduced invasiveness and good cosmetic effects.

Three-Year Follow-Up of Laparoscopic Reduced Port Sleeve Gastrectomy in 808 Consecutive Patients

BACKGROUND

Sleeve gastrectomy (SG) is a very popular technique for the treatment of morbid obesity. Less and less invasive laparoscopic approaches to SG have been proposed and shown to be safe and feasible.

OBJECTIVES

We developed a reduced port laparoscopic approach to sleeve gastrectomy (_RLSG) with the aim to further optimize the advantages of laparoscopy. Preliminary and safety profile of _RLSG as well as 3 years weight loss outcome are hereby discussed.

SETTING

University Hospital, Kuwait.

MATERIALS AND METHODS

All patients had morbid obesity with history of failure of conservative treatment. The _RLSG procedure was performed using only two skin incisions.

RESULTS

The analyzed population comprised 808 patients, including 642 women and 166 men. Mean age and BMI were 28.34 ± 8.37 and 41.09 ± 6.34, respectively. Mean operative time was 43 ± 20 min (range, 31-185). Mortality was nil. Overall morbidity rate was (4.5%). Three patients had postoperative leak (0.4%). Median duration of hospital stay was 2 days (range, 1-5). Mean percentage of excess weight loss (% EWL) was 23.18 ± 17.3% at 1 month, 55.08 ± 22.9% at 6 months, 82.6 ± 22.6% at 1 year, and 84.3 ± 22.4% at 3 years. Mean percentage total weight loss (%TWL) was 9.34% at 1 month, 22.42% at 6 months, and 34.57% at 1 year.

CONCLUSION

_RLSG is a safe and effective surgical option in patients with morbid obesity. Moreover, 3-year follow-up assessment confirmed adequate % EWL.

Safety of single-incision laparoscopic cholecystectomy for acute cholecystitis

BACKGROUND

Single-incision laparoscopic cholecystectomy (SILC) is a common procedure performed worldwide. In this study, we evaluated the safety and efficacy of SILC for acute cholecystitis.

METHODS

Patients who underwent SILC between September 2012 and December 2016 were retrospectively enrolled and divided into acute and chronic groups. Demographic, operative and outcome data were obtained by reviewing medical records, physical examination and telephone follow-up.

RESULTS

In total, 1435 patients were included in this study: 220 (15.3%) in the acute group and 1215 (84.7%) in the chronic group. The mean operative time was longer in the acute group than in the chronic group (44.7 ± 21.6 versus 32.8 ± 9.8 min; P < 0.001). Insertion of additional ports was performed in 17 patients: six in the acute group and 11 in the chronic group. Conversion to abdominal laparotomy was performed in eight patients: one in the acute group and seven in the chronic group. The mean post-operative hospital stay was 31.7 ± 20.4 h in the acute group and 27.7 ± 13.7 h in the chronic group. The complication rate was similar between the acute (n = 8, 3.6%) and chronic (n = 33, 2.7%) groups.

CONCLUSION

SILC does not increase the complication rate and is a safe and feasible technique for both chronic and acute cholecystitis.

Three-Port Versus Five-Port Laparoscopic Distal Gastrectomy for Early Gastric Cancer Patients: A Propensity Score Matched Case-Control Study

AIM

The aim of this study was to evaluate the feasibility and safety of three-port laparoscopic distal gastrectomy (TP-LDG) as a reduced port laparoscopic gastrectomy.

MATERIALS AND METHODS

We retrospectively identified 146 patients preoperatively diagnosed with early gastric cancer who underwent five-port laparoscopic distal gastrectomy (FP-LDG) or TP-LDG between May 2013 and July 2016. A propensity score matching analysis was used to create patient groups (48 patients in each group) matched for sex, age, body mass index, previous abdominal surgery history, and American Society of Anesthesiologist score. The short-term surgical outcomes between TP-LDG and FP-LDG were compared.

RESULTS

The TP-LDG group had a statistically shorter umbilical wound length [3.4 (range, 3.0-4.0) cm vs. 3.9 (range, 3.7-4.0) cm, p = .000], shorter operative time [230 (range, 190-310) min vs. 250 (range, 180-320) min, p = .036], and lower estimated blood loss [68 (range, 20-180) mL vs. 80 (range, 40-150) mL, p = .005] compared to that in the FP-LDG group. However, there was no specific superiority regarding inflammatory profiles. Complication rates were also similar (8.4% TP-LDG vs. 12.6% FP-LDG, p = .504).

CONCLUSIONS

TP-LDG is a feasible and safe surgical procedure for the patients with early gastric cancer and provides the benefit of better cosmesis.

Three-Trocar Sleeve Gastrectomy vs Standard Five-Trocar Technique: a Randomized Controlled Trial

PURPOSE

Bariatric surgery is a treatment for morbid obesity. Different surgical procedures have been described in order to obtain excess weight loss (EWL), but currently laparoscopic sleeve gastrectomy is the most commonly performed procedure throughout the world. Reducing abdominal wall trauma and increasing the aesthetic result are important goals for all bariatric surgeons. We conducted a randomized, controlled trial in order to assess if the three-trocar sleeve gastrectomy can be safely carried out or should be abandoned.

MATERIALS AND METHODS

From September 2016 to February 2017, 90 patients were enrolled in our trial. Each patients was evaluated by a multidisciplinary team before surgery. Two groups were created after application of the inclusion and exclusion criteria. The primary endpoint was to define the features of early post-operative complications of patients in group 1 (the three-trocar technique-the experimental group) compared to group 2 (five-trocar technique-the control group). The secondary endpoints were to evaluate any differences between the two groups concerning post-operative pain and patients' satisfaction with the aesthetic results.

RESULTS

There was no difference between the two groups concerning age, sex distribution, weight, and BMI. The rate of co-morbidities was similar in both groups. Operative time was inferior in the control group, but patient satisfaction was better in the three-trocar sleeve gastrectomy group.

CONCLUSIONS

The three-trocar sleeve gastrectomy can be safely carried out with a modest increase in operative time, without additional early surgical complications and with a greater patient aesthetic satisfaction.

TRIAL REGISTRATION

researchregistry2386.

Three Trocars Laparoscopic Total Gastrectomy + D2 Lymphadenectomy with Intracorporeal Manual Esojejunostomy

BACKGROUND

Minimally invasive surgery (MIS) is proved to be feasible and safe oncologically. In the past decade, a new philosophy of MIS, reducing abdominal trauma and improving the cosmetic results, has been popularized. ^1-3 The authors report a three trocars laparoscopic total gastrectomy + D2 lymphadenectomy for lesser curvature gastric adenocarcinoma.

VIDEO

A 52-year-old woman presenting a nondifferentiated gastric adenocarcinoma at the incisura angularis was admitted at consultation. Preoperative workup showed a T3N+M0 tumor. After neoadjuvant chemotherapy, laparoscopy was scheduled. Three trocars (5, 12, 5 mm) were placed in the abdomen. The operative field's exposure was improved by temporary percutaneous sutures. En bloc total gastrectomy and omentectomy was performed with a D2 lymphadenectomy, including the nodes of the stations 1, 2, 3, 4, 5, 6, 7, 8a, 8p, 9, 10, 11p, 11d, and 12a. Completely manual end-to-side esophago-jejunal anastomosis (Fig. 1a, b) and linear mechanical side-to-side jejuno-jejunal anastomosis were realized with the closure of both mesenteric and mesocolic defects. The specimen was retrieved through a suprapubic access.

RESULTS

Operative time was 4 hours and 45 minutes (anastomosis: 30), and perioperative bleeding was 100 cc. Pathologic report confirmed nondifferentiated adenocarcinoma, mucinous, G3, infiltrating entirely the gastric wall, with 63 (4 positive) nodes removed; 7 edition UICC stage: pT4aN2aM0; keratine AE1/AE3 negative, HER2/neu, and HER2/CEP17 nonamplified. During postoperative follow-up, no recurrence was detected after 2 years.

CONCLUSIONS

Reduced port laparoscopic surgery provides the same quality of oncologic surgery as conventional multitrocar laparoscopy with added superior cosmesis and reduced abdominal trauma.

Reduced port laparoscopic gastrectomy for gastric cancer

The use of reduced port laparoscopic surgery (RPS) has become increasingly popular. The concept of RPS includes all procedures derived from various efforts minimizing the invasiveness of surgery, with single-incision laparoscopic surgery (SILS) being the ultimate reduced port technique. Reduced-port laparoscopic gastrectomy (RPLG) for gastric cancer has not yet been fully established and still has issues such as feasibility, oncological validity, training, and education. The short-term results of reported studies are acceptable. However, long-term results that verify positive results or radical cure even in cases of cancer have not yet been published. Patients for whom RPLG is indicated should be selected carefully. Prospective multicenter studies should be conducted to establish RPS as a truly evidence-based practice that addresses not only cosmesis but also the appropriate balance between minimal invasiveness and radical cure.

Early experience of duet laparoscopic distal gastrectomy (duet-LDG) using three abdominal ports for gastric carcinoma: surgical technique and comparison with conventional laparoscopic distal gastrectomy

BACKGROUND

Reduced port laparoscopic surgery may lead to less pain and better cosmetic outcome than conventional surgery. Also, it requires fewer assistants and abdominal ports. Recently, some experts have reported operative techniques and outcomes of reduced port laparoscopic gastrectomy. In this study, we sought to introduce our techniques of duet laparoscopic distal gastrectomy (duet-LDG) using three abdominal ports and surgical outcomes of early experience of this procedure.

METHODS

Between 2010 and 2014, 431 patients undergoing LDG for gastric carcinoma were retrospectively reviewed. Among them, 49 patients underwent duet-LDG. During duet-LDG, an operator performed all the procedures using two abdominal ports with an additional umbilical laparoscopy port. Short-term surgical outcomes of duet-LDG were compared with conventional LDG groups.

RESULTS

The mean age of the duet-LDG group was 61.1 years with 38 males and 11 females. Forty patients underwent Billroth II, and 9 patients underwent Roux-en-Y reconstruction. The mean operating time was 147 min, and the mean intraoperative blood loss was 49 ml. Duet-LDG was successfully completed without intraoperative complications or open conversion in all patients. After an operation, six patients (12.2 %) developed postoperative complications, and no mortality occurred. The mean hospital stay was 8.6 days. When compared with the conventional LDG groups, patients who underwent duet-LDG showed no significant differences in short-term surgical outcomes including morbidity, mortality, and the duration of hospital stay.

CONCLUSIONS

Duet-LDG is a viable alternative to conventional LDG for treating early gastric carcinoma providing comparable surgical outcomes. Less operative pain and scar, reduced medical cost, and requiring fewer assistants may benefit patients as well as surgeons. Finally, the efficacy of duet-LDG needs to be evaluated in diverse clinical aspects.

Feasibility of single-incision laparoscopic cholecystectomy for acute cholecystitis

AIM: To assess the safety of single-incision laparoscopic cholecystectomy (SILC) for acute cholecystitis.

METHODS: All patients who underwent SILC at Sano Hospital (Kobe, Japan) between January 2010 and December 2014 were included in this retrospective study. Clinical data related to patient characteristics and surgical outcomes were collected from medical records. The parameters for assessing the safety of the procedure included operative time, volume of blood loss, achievement of the critical view of safety, use of additional trocars, conversion to laparotomy, intraoperative and postoperative complications, and duration of postoperative hospital stay. Patient backgrounds were statistically compared between those with and without conversion to laparotomy.

RESULTS: A total of 100 patients underwent SILC for acute cholecystitis during the period. Preoperative endoscopic treatment was performed for suspected choledocholithiasis in 41 patients (41%). The mean time from onset of acute cholecystitis was 7.7 d. According to the Updated Tokyo Guidelines (TG13) for the severity of cholecystitis, 86 and 14 patients had grade I and grade II acute cholecystitis, respectively. The mean operative time was 87.4 min. The mean estimated blood loss was 80.6 mL. The critical view of safety was obtained in 89 patients (89%). Conversion laparotomy was performed in 12 patients (12%). Postoperative complications of Clavien-Dindo grade III or greater were observed in 4 patients (4%). The mean duration of postoperative hospital stay was 5.7 d. Patients converted from SILC to laparotomy tended to have higher days after onset.

CONCLUSION: SILC is feasible for acute cholecystitis; in addition, early surgical intervention may reduce the risk of laparotomy conversion.