We use cookies to offer you an optimal experience on our website. By browsing our website, you accept the use of cookies.
Filter by
Specialty
View more
Clear filter Media type
View more
Clear filter Category
View more
Publication date
Sort by:
Laparoscopic total D2 gastrectomy for cancer
Laparoscopic gastrectomy is accepted as a treatment of choice for gastric cancer due to low postoperative pain, faster recovery, shorter hospital stay, and a better cosmetic outcome as compared to open gastrectomy. Radical gastrectomy, with lymph node dissection, is essential to cure this type of cancer. This technique can be reproduced also in third world countries.
This is the case of a 74-year-old woman who was evaluated for dyspepsia and weight loss. Upper endoscopy found a tumor near the cardia on the lesser curvature. The biopsy study confirmed the presence of an adenocarcinoma. CT-scan showed no metastasis or lymph nodes affected. Surgical treatment was decided upon along with a laparoscopic total D2 gastrectomy.
F Signorini, S Reimondez, M España, L Obeide, F Moser
Surgical intervention
1 year ago
9893 views
426 likes
0 comments
06:41
Laparoscopic total D2 gastrectomy for cancer
Laparoscopic gastrectomy is accepted as a treatment of choice for gastric cancer due to low postoperative pain, faster recovery, shorter hospital stay, and a better cosmetic outcome as compared to open gastrectomy. Radical gastrectomy, with lymph node dissection, is essential to cure this type of cancer. This technique can be reproduced also in third world countries.
This is the case of a 74-year-old woman who was evaluated for dyspepsia and weight loss. Upper endoscopy found a tumor near the cardia on the lesser curvature. The biopsy study confirmed the presence of an adenocarcinoma. CT-scan showed no metastasis or lymph nodes affected. Surgical treatment was decided upon along with a laparoscopic total D2 gastrectomy.
Laparoscopic total gastrectomy guided by fluorescent lymphangiography using ICG injection around a tumor, followed by an intracorporeal double stapling esophagojejunostomy
Injecting indocyanine green (ICG) around the tumor enables the operators to identify the lymphatic channels and the lymph nodes in which the cancer cells can spread. It also allows them to decide on the extent of the dissection and validate the completeness of lymph node dissection. In this video, a laparoscopic near-infrared fluorescent camera was used, showing the fluorescent signal in diverse modes. A total gastrectomy with D1+ dissection is performed. The fluorescent signal shows the possible lymphatic pathways during the operation. An intracorporeal esophagojejunostomy was performed in a double stapling fashion; a round needle and a surgical thread are attached to the plastic part of the anvil of the circular stapler.
HK Yang, SH Kong
Surgical intervention
2 years ago
1774 views
78 likes
0 comments
15:56
Laparoscopic total gastrectomy guided by fluorescent lymphangiography using ICG injection around a tumor, followed by an intracorporeal double stapling esophagojejunostomy
Injecting indocyanine green (ICG) around the tumor enables the operators to identify the lymphatic channels and the lymph nodes in which the cancer cells can spread. It also allows them to decide on the extent of the dissection and validate the completeness of lymph node dissection. In this video, a laparoscopic near-infrared fluorescent camera was used, showing the fluorescent signal in diverse modes. A total gastrectomy with D1+ dissection is performed. The fluorescent signal shows the possible lymphatic pathways during the operation. An intracorporeal esophagojejunostomy was performed in a double stapling fashion; a round needle and a surgical thread are attached to the plastic part of the anvil of the circular stapler.
Laparoscopic total gastrectomy and D2 dissection guided by fluorescence imaging system, followed by esophagojejunostomy using an intracorporeal purse-string suture method
This video demonstrates a case of gastric cancer, which is located at the cardia, and a total gastrectomy was planned. For D2 dissection in a total gastrectomy, lymph node dissection around the splenic artery and splenic hilum is one of the most challenging area. Here, we present an example of complete dissection by following the plane around the splenic vessels.
Fluorescence imaging using indocyanine green (ICG) is a promising technology not only for sentinel node navigation surgery but it is also a guide for extensive lymph node dissection. The laparoscopic fluorescence imaging system was used here as a guidance and assessment tool for complete lymph node dissection. Also, an original method for intracorporeal esophagojejunal anastomosis is introduced, which enables purse-string suture and insertion of the anvil of the circular stapler in a quite stable manner, and reproduces conventional esophagojejunostomy without specialized devices.
HK Yang, SH Kong
Surgical intervention
4 years ago
2790 views
51 likes
0 comments
28:29
Laparoscopic total gastrectomy and D2 dissection guided by fluorescence imaging system, followed by esophagojejunostomy using an intracorporeal purse-string suture method
This video demonstrates a case of gastric cancer, which is located at the cardia, and a total gastrectomy was planned. For D2 dissection in a total gastrectomy, lymph node dissection around the splenic artery and splenic hilum is one of the most challenging area. Here, we present an example of complete dissection by following the plane around the splenic vessels.
Fluorescence imaging using indocyanine green (ICG) is a promising technology not only for sentinel node navigation surgery but it is also a guide for extensive lymph node dissection. The laparoscopic fluorescence imaging system was used here as a guidance and assessment tool for complete lymph node dissection. Also, an original method for intracorporeal esophagojejunal anastomosis is introduced, which enables purse-string suture and insertion of the anvil of the circular stapler in a quite stable manner, and reproduces conventional esophagojejunostomy without specialized devices.
Total gastrectomy for early gastric cancer and giant paraesophageal hernia
This video shows a total gastrectomy in an 83-year-old woman with a giant type III paraesophageal hernia and an early gastric cancer located at the middle third of the stomach. First, type III paraesophageal hernia dissection with complete resection of the hernia sac is shown. A D1 lymphadenectomy is performed.
The esophagus is transected high in the posterior mediastinum and an end-to-side esophago-jejunostomy is performed using the Orvil™ orogastric tube and the EEA™ DST XL 25 circular stapling device. The esophago-jejunostomy is performed in a Roux-en-Y fashion. The alimentary limb is ascended through the transverse mesocolon. The skin incision used for trocar placement in the upper left abdomen (right hand of the surgeon) was slightly enlarged to allow for specimen extraction. Through this incision, the side-to-side jejuno-jejunostomy was performed extracorporeally.
P Vorwald, M de Vega Irañeta, E Bernal, D Cortés, S Ayora González, A Gomez Valdazo
Surgical intervention
5 years ago
3188 views
36 likes
0 comments
16:26
Total gastrectomy for early gastric cancer and giant paraesophageal hernia
This video shows a total gastrectomy in an 83-year-old woman with a giant type III paraesophageal hernia and an early gastric cancer located at the middle third of the stomach. First, type III paraesophageal hernia dissection with complete resection of the hernia sac is shown. A D1 lymphadenectomy is performed.
The esophagus is transected high in the posterior mediastinum and an end-to-side esophago-jejunostomy is performed using the Orvil™ orogastric tube and the EEA™ DST XL 25 circular stapling device. The esophago-jejunostomy is performed in a Roux-en-Y fashion. The alimentary limb is ascended through the transverse mesocolon. The skin incision used for trocar placement in the upper left abdomen (right hand of the surgeon) was slightly enlarged to allow for specimen extraction. Through this incision, the side-to-side jejuno-jejunostomy was performed extracorporeally.
Minimally invasive redo esophagojejunostomy for postoperative dehiscence after laparoscopic total gastrectomy for gastric cancer
This is the case of an 87-year-old man receiving dual antiplatelet therapy, with aortic steno-insufficiency, chronic heart and renal failure, admitted to our service for anemia due to lesser curvature gastric cancer.
The patient underwent an uneventuful laparoscopic total gastrectomy with D1 lymph node dissection with Roux-en-Y reconstruction. Pathological findings were consistent with a poorly differentiated pT4bN2M0 adenocarcinoma (TNM classification, 7th edition).
A fifth postoperative day gastrografin swallow revealed a large anastomotic leak at the esophagojejunostomy.
A conservative approach was considered to treat this complication with a multispecialty approach. However, this approach was rejected for two reasons:
- Firstly, the occurrence of a broad anastomotic leakage in the early postoperative period is often due to necrosis of perianastomotic tissues;
- Secondly, the patient’s age, the poor nutritional status and the early signs of hemodynamic instability - hypertension and tachycardia - called for a more timely and potentially resolutive approach.
Additionally, in our experience, the use of self-expandable metallic stents is associated with a high rate of stent migration in the setting of end-to-side anastomoses.
As a result, a decision was made to perform an emergency explorative laparoscopy with a minimally invasive redo esophagojejunostomy.
The procedure was performed using 5 trocars through the same incisions as the first surgery. Operative time was 180 minutes, with minimal blood loss and no intraoperative transfusion.

Results:
After surgery, the patient required admission to the postoperative intensive care unit for 9 days because of respiratory failure, hemodynamic instability, and the development of a subdiaphragmatic collection, treated by percutaneous drainage.
An upper gastrointestinal gastrografin swallow on postoperative day 10 showed a patent esophagojejunostomy without any leak. The patient was started on a clear fluid diet, and advanced to a solid diet as tolerated, until discharge on postoperative day 14.
I Maruri Chimeno, I Otero Martinez, V Vigorita, M Bertucci Zoccali, H Pardellas Rivera, P Troncoso Pereira , JE Casal Núñez
Surgical intervention
5 years ago
1459 views
16 likes
0 comments
12:54
Minimally invasive redo esophagojejunostomy for postoperative dehiscence after laparoscopic total gastrectomy for gastric cancer
This is the case of an 87-year-old man receiving dual antiplatelet therapy, with aortic steno-insufficiency, chronic heart and renal failure, admitted to our service for anemia due to lesser curvature gastric cancer.
The patient underwent an uneventuful laparoscopic total gastrectomy with D1 lymph node dissection with Roux-en-Y reconstruction. Pathological findings were consistent with a poorly differentiated pT4bN2M0 adenocarcinoma (TNM classification, 7th edition).
A fifth postoperative day gastrografin swallow revealed a large anastomotic leak at the esophagojejunostomy.
A conservative approach was considered to treat this complication with a multispecialty approach. However, this approach was rejected for two reasons:
- Firstly, the occurrence of a broad anastomotic leakage in the early postoperative period is often due to necrosis of perianastomotic tissues;
- Secondly, the patient’s age, the poor nutritional status and the early signs of hemodynamic instability - hypertension and tachycardia - called for a more timely and potentially resolutive approach.
Additionally, in our experience, the use of self-expandable metallic stents is associated with a high rate of stent migration in the setting of end-to-side anastomoses.
As a result, a decision was made to perform an emergency explorative laparoscopy with a minimally invasive redo esophagojejunostomy.
The procedure was performed using 5 trocars through the same incisions as the first surgery. Operative time was 180 minutes, with minimal blood loss and no intraoperative transfusion.

Results:
After surgery, the patient required admission to the postoperative intensive care unit for 9 days because of respiratory failure, hemodynamic instability, and the development of a subdiaphragmatic collection, treated by percutaneous drainage.
An upper gastrointestinal gastrografin swallow on postoperative day 10 showed a patent esophagojejunostomy without any leak. The patient was started on a clear fluid diet, and advanced to a solid diet as tolerated, until discharge on postoperative day 14.
Laparoscopic total gastrectomy with D2 lymphadenectomy for adenocarcinoma
Total gastrectomy with D2 lymphadenectomy is recommended for T1-T2 gastric cancer.
The laparoscopic approach for this procedure has been validated by extensive clinical randomized trials in Asia, leading to fewer postoperative complications and morbidity and identical oncological outcome.
This video presents a laparoscopic total gastrectomy with D2 lymphadenectomy in a 54-year-old woman presenting with a T1-T2 poorly differentiated adenocarcinoma of the lesser curvature of the stomach. Due to the location of the tumor, lymphadenectomy of stations 10 and 11d are not performed. An original technique of circular eso-jejunal anastomosis is described.
A Talvane Torres de Oliveira, C Lacerda, PA Bertulucci
Surgical intervention
6 years ago
5196 views
79 likes
0 comments
25:53
Laparoscopic total gastrectomy with D2 lymphadenectomy for adenocarcinoma
Total gastrectomy with D2 lymphadenectomy is recommended for T1-T2 gastric cancer.
The laparoscopic approach for this procedure has been validated by extensive clinical randomized trials in Asia, leading to fewer postoperative complications and morbidity and identical oncological outcome.
This video presents a laparoscopic total gastrectomy with D2 lymphadenectomy in a 54-year-old woman presenting with a T1-T2 poorly differentiated adenocarcinoma of the lesser curvature of the stomach. Due to the location of the tumor, lymphadenectomy of stations 10 and 11d are not performed. An original technique of circular eso-jejunal anastomosis is described.
Totally laparoscopic total gastrectomy for stage IIIA (cT3 cN1 cM0) advanced gastric carcinoma
A 66-year-old man was admitted to our hospital with complaints of epigastric pain. His hemoglobin level was 9.3g/dL. Endoscopy of the upper gastrointestinal tract (EGD) showed an advanced gastric carcinoma that had invaded the middle and lower third of the stomach. A biopsy specimen revealed a moderately differentiated adenocarcinoma. Abdominal computed tomography (CT) showed that the tumor had invaded the stomach wall. Enlarged lymph nodes were present only around the lesser curvature (regional lymph nodes No. 3). The patient was diagnosed with stage IIIA (cT3 cN1 cM0) advanced gastric carcinoma according to the Japanese classification of gastric carcinoma1. The patient was then taken to the operating room for exploratory laparoscopy and laparoscopic total gastrectomy with D2 lymphadenectomy. The operation time was 260 minutes. No further evidence of intra-abdominal disease or liver involvement was noted. The patient did well postoperatively and was subsequently discharged home on postoperative day 9. Four metastatic lymph nodes/twenty eight regional lymph nodes were found; so the pathological findings confirmed stage IIIA. The patient is disease-free at 10 months. Japanese Classification of Gastric Carcinoma - 2nd English Edition. Gastric Cancer 1998;1:10-24.
G Pignata, M Barone, U Bracale, E Gianetta, F Badessi
Surgical intervention
9 years ago
5366 views
34 likes
0 comments
26:02
Totally laparoscopic total gastrectomy for stage IIIA (cT3 cN1 cM0) advanced gastric carcinoma
A 66-year-old man was admitted to our hospital with complaints of epigastric pain. His hemoglobin level was 9.3g/dL. Endoscopy of the upper gastrointestinal tract (EGD) showed an advanced gastric carcinoma that had invaded the middle and lower third of the stomach. A biopsy specimen revealed a moderately differentiated adenocarcinoma. Abdominal computed tomography (CT) showed that the tumor had invaded the stomach wall. Enlarged lymph nodes were present only around the lesser curvature (regional lymph nodes No. 3). The patient was diagnosed with stage IIIA (cT3 cN1 cM0) advanced gastric carcinoma according to the Japanese classification of gastric carcinoma1. The patient was then taken to the operating room for exploratory laparoscopy and laparoscopic total gastrectomy with D2 lymphadenectomy. The operation time was 260 minutes. No further evidence of intra-abdominal disease or liver involvement was noted. The patient did well postoperatively and was subsequently discharged home on postoperative day 9. Four metastatic lymph nodes/twenty eight regional lymph nodes were found; so the pathological findings confirmed stage IIIA. The patient is disease-free at 10 months. Japanese Classification of Gastric Carcinoma - 2nd English Edition. Gastric Cancer 1998;1:10-24.
Laparoscopic total gastrectomy for pT2 N0 M0 adenocarcinoma of the lesser curvature of the stomach
Totally laparoscopic gastrectomy for cancer remains limited because of technical problems, expecially for lymphadenectomy. We present the case of a 75-year-old patient with no specific history in which an adenocarcinoma of the lesser curvature of the stomach was found. An endoscopic ultrasound had shown a UST3 N0 lesion. The CT-scan confirmed the absence of secondary lesion and a neoadjuvant chemotherapy was carried out. Following chemotherapy, a re-evaluation was performed and confirmed the 2 by 2cm lesion of the lesser curvature of the stomach without secondary lesion. The decision to perform a laparoscopic total gastrectomy was made.
B Dallemagne, F Costantino, J Marescaux
Surgical intervention
9 years ago
7594 views
23 likes
0 comments
15:53
Laparoscopic total gastrectomy for pT2 N0 M0 adenocarcinoma of the lesser curvature of the stomach
Totally laparoscopic gastrectomy for cancer remains limited because of technical problems, expecially for lymphadenectomy. We present the case of a 75-year-old patient with no specific history in which an adenocarcinoma of the lesser curvature of the stomach was found. An endoscopic ultrasound had shown a UST3 N0 lesion. The CT-scan confirmed the absence of secondary lesion and a neoadjuvant chemotherapy was carried out. Following chemotherapy, a re-evaluation was performed and confirmed the 2 by 2cm lesion of the lesser curvature of the stomach without secondary lesion. The decision to perform a laparoscopic total gastrectomy was made.