Advanced technique of reduced-port proximal gastrectomy for gastric cancer
Proximal gastrectomy (PG) has potential advantages over total gastrectomy, such as pre-serving gastric capacity and entailing fewer hormonal and nutritional deficiencies for upper third gastric cancer patients. Following PG, various reconstruction methods are reported, but no general agreement exists regarding the optimal reconstructive procedure. Fur-thermore, because of the technical difficulties related to lymph node dissection and recon-struction, reduced-port surgery (RPS) has rarely been applied for laparoscopic PG. This report describes the technical details of reduced-port proximal gastrectomy (RPPG) for gastric cancer. We performed RPPG using an E-Z AccessTM oval type device with a scope trocar (and an operator’s right-hand trocar) through an umbilical incision, plus an additional two or three 2.7-mm trocars (MiniportTM; Medtronic, Dublin, Ireland). A needlescopic device (EndoRelief device; Hope Denshi Co., Ltd., Chiba, Japan), which had a 2.4-mm diameter shaft with a 5-mm diameter jaw, was introduced through the Mini-portTM. After PG, reconstruction was performed by intracorporeal esoph-ago-gastrostomy (hinged double flap method, Kamikawa’s procedure), which minimizes the postoperative esophageal reflux. All routine procedures performed via conventional lapa-roscopic PG were achieved in RPPG. This chapter describes the techniques involved in RPPG for gastric cancer using an oval-shaped port device and needlescopic forceps.