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Subtotal gastrectomy and D1+ lymphadenectomy for distal stage IB gastric cancer with preservation of an accessory left hepatic artery
This video shows a partial gastrectomy in a 63-year-old woman with a stage IB gastric cancer located at the distal third of the stomach. The lesion was located using intraoperatory endoscopy. We found an accessory left hepatic artery originating from the left gastric artery, which was preserved. The gastrojejunostomy was performed in a Roux-en-Y fashion. The alimentary limb was ascended through the transverse mesocolon. The jejunojejunostomy was performed in a latero-lateral fashion with closure of the ostium with simple Ethibond 2/0 stitches. 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.
P Vorwald, R Restrepo, G Salcedo, M Posada
Surgical intervention
2 years ago
2906 views
233 likes
0 comments
11:41
Subtotal gastrectomy and D1+ lymphadenectomy for distal stage IB gastric cancer with preservation of an accessory left hepatic artery
This video shows a partial gastrectomy in a 63-year-old woman with a stage IB gastric cancer located at the distal third of the stomach. The lesion was located using intraoperatory endoscopy. We found an accessory left hepatic artery originating from the left gastric artery, which was preserved. The gastrojejunostomy was performed in a Roux-en-Y fashion. The alimentary limb was ascended through the transverse mesocolon. The jejunojejunostomy was performed in a latero-lateral fashion with closure of the ostium with simple Ethibond 2/0 stitches. 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.
Totally laparoscopic subtotal gastrectomy with D2 lymphadenectomy for stage II (cT3 cN0 cM0) advanced gastric carcinoma
A 54-year-old female patient with a past medical history of hypertension presented with abdominal pain and an episode of coffee ground emesis. Symptoms of pain and vomiting started approximately two to three months before admission and began to worsen over the past month. The pain was relieved by food. The patient also admitted to unspecified weight loss over the same period of time. On physical examination, mild distension of the abdomen was observed with a mild to moderate tenderness to palpation involving epigastric tenderness. An endoscopy of the upper gastrointestinal tract (EGD) revealed a gastric ulcer extending to the lower part of the stomach. No active bleeding was observed at the site. Gastric outlet obstruction was also noted with an inflamed edematous pylorus. Biopsy revealed a moderately differentiated gastric carcinoma. Staging CT-scan imaging studies revealed no sites of metastasis. The patient was diagnosed with stage II (cT3 cN0 cM0) advanced gastric carcinoma according to the Japanese classification of gastric carcinoma. The patient was then taken to the operating room for laparoscopic subtotal gastrectomy with D2 lymphadenectomy. The operation time was 220 minutes. No further evidence of intra-abdominal disease or liver involvement was observed. The patient did well postoperatively and was subsequently discharged home on postoperative day 7. No metastatic lymph nodes / twenty-two regional lymph nodes were found; so the pathological findings confirmed stage II. The patient is disease-free at 12 months.
Japanese Classification of Gastric Carcinoma - 2nd English Edition. Gastric Cancer 1998;1:10-24.
G Pignata, U Bracale, M Barone, F Perna, P Becchi
Surgical intervention
9 years ago
6643 views
70 likes
0 comments
25:53
Totally laparoscopic subtotal gastrectomy with D2 lymphadenectomy for stage II (cT3 cN0 cM0) advanced gastric carcinoma
A 54-year-old female patient with a past medical history of hypertension presented with abdominal pain and an episode of coffee ground emesis. Symptoms of pain and vomiting started approximately two to three months before admission and began to worsen over the past month. The pain was relieved by food. The patient also admitted to unspecified weight loss over the same period of time. On physical examination, mild distension of the abdomen was observed with a mild to moderate tenderness to palpation involving epigastric tenderness. An endoscopy of the upper gastrointestinal tract (EGD) revealed a gastric ulcer extending to the lower part of the stomach. No active bleeding was observed at the site. Gastric outlet obstruction was also noted with an inflamed edematous pylorus. Biopsy revealed a moderately differentiated gastric carcinoma. Staging CT-scan imaging studies revealed no sites of metastasis. The patient was diagnosed with stage II (cT3 cN0 cM0) advanced gastric carcinoma according to the Japanese classification of gastric carcinoma. The patient was then taken to the operating room for laparoscopic subtotal gastrectomy with D2 lymphadenectomy. The operation time was 220 minutes. No further evidence of intra-abdominal disease or liver involvement was observed. The patient did well postoperatively and was subsequently discharged home on postoperative day 7. No metastatic lymph nodes / twenty-two regional lymph nodes were found; so the pathological findings confirmed stage II. The patient is disease-free at 12 months.
Japanese Classification of Gastric Carcinoma - 2nd English Edition. Gastric Cancer 1998;1:10-24.