Dual port distal gastrectomy

Recently, the trend in laparoscopic procedures has been toward minimizing the number of incisions to reduce invasiveness. Our dual port approach potentiates less invasive surgery for early gastric cancer located in the middle or distal stomach. In this report, we describe how to perform this procedure. Seventeen patients who were diagnosed as having early stage gastric cancer, and one patient with a duodenal ulcer, were offered the dual port approach. Mean age and body mass index (BMI) were 67.6 and 22.2, respectively. A 5-mm flexible scope (Olympus, Tokyo, Japan) and SILS-Port (Covidien, Tokyo, Japan) were used in all cases. A nylon ligature with a straight needle, instead of a surgical instrument, was available to raise the gastric wall to visualize bursa space and neighboring organs. This nylon ligature is also useful for closing the suture hole with an Endo-GIA (Covidien, Tokyo, Japan). An additional 12-mm port can avoid the interference of surgical instruments due to the lack of triangulation. Outcomes of this surgery were acceptable with no short-term complication experienced by any of cases. In addition, port-related complications such as organ damage, adhesion, bleeding, wound infection and hernias may be less frequent because of the lower number of ports.