Evaluation of the safety and efficacy of esophagojejunostomy after totally laparoscopic total gastrectomy using a trans-orally inserted anvil: a single-center comparative study

Background

Although laparoscopic surgery is frequently performed for the treatment of gastric cancer, laparoscopic total gastrectomy is not widely performed because of its technical difficulty. Since December 2007 we have performed esophagojejunostomy after totally laparoscopic total gastrectomy (TLTG) in more than 110 cases in our institution by using a circular stapler with a trans-orally inserted anvil. We performed a single-center comparative study to evaluate the safety and efficacy of esophagojejunostomy using a trans-orally inserted anvil in patients who underwent TLTG for the treatment of gastric cancer.

Methods

In the present study, we examined 329 patients with gastric cancer who underwent esophagojejunostomy using a circular stapler after total gastrectomy. Data on the clinicopathological features, operative time, amount of intraoperative blood loss, and incidence of anastomosis-related complications among the surgical groups were obtained by reviewing the medical records, which were then analyzed.

Results

Approximately 67 % of the patients were men, and the average patient age was 64.0 years (range 26–93 years). In addition, 166 (50.5 %) and 163 (49.5 %) patients underwent open and laparoscopic surgery, respectively. Leakage following esophagojejunostomy was noted in 7 (4.2 %) of 166 patients who underwent total gastrectomy with open laparotomy, and 0 of 46 patients who underwent laparoscopic-assisted total gastrectomy (LATG). However, only 2 (1.7 %) of 117 patients who underwent TLTG using a trans-orally inserted anvil exhibited leakage following esophagojejunostomy. Anastomotic stenosis of the esophagojejunostomy was observed in 5 (3.0 %) of 166 patients who underwent total gastrectomy with open laparotomy, 2 (4.3 %) of 46 patients who underwent LATG, and 2 (1.7 %) of 117 patients who underwent TLTG using a trans-orally inserted anvil.

Conclusions

We believe that esophagojejunostomy using a trans-orally inserted anvil after TLTG for gastric cancer is a safe and useful surgical procedure.     

Short-Term Outcomes of Totally Laparoscopic Total Gastrectomy: Experience With the First Consecutive 112 Cases

Introduction

Although laparoscopic distal gastrectomy has become a viable treatment option for gastric cancer, laparoscopic total gastrectomy remains in limited use.

Purpose

The present study was designed to evaluate the short-term outcomes of totally laparoscopic total gastrectomy (TLTG).

Methods

The records of 112 consecutive patients who underwent TLTG for gastric cancer between September 2006 and November 2012 were reviewed, and surgical outcomes were retrospectively investigated.

Results

Neoadjuvant chemotherapy was given to 21 patients (18.8 %). The degree of lymphadenectomy was D1+ in 83 patients (74.1 %) and D2 in 29 (25.9 %). The operation time was 359 min, median intraoperative blood loss was 85 ml, and median total number of harvested lymph nodes was 64. Grade II or higher postoperative complications developed in 25 patients (22.3 %). On univariate analysis, pathologic stages IB to IV (versus stage IA) overlapped esophagojejunostomy (versus functional end-to-end esophagojejunostomy) and operation time >360 min (versus ≤360 min) were related to postoperative morbidity. In the multivariate analysis, operative time and pathologic stage were independent risk factors for postoperative complications.

Conclusions

TLTG is feasible and can be performed with acceptable postoperative morbidity. A longer operating time and more advanced pathologic stage were significantly associated with higher postoperative morbidity.     

Outcome of functional end-to-end esophagojejunostomy in totally laparoscopic total gastrectomy

Purpose

Totally laparoscopic total gastrectomy (TLTG) is unpopular because reconstruction is difficult. In fact, esophagojejunostomy is the most difficult surgical technique in TLTG. We adopted functional end-to-end anastomosis for esophagojejunostomy to simplify the procedure. The present study assesses the feasibility and surgical outcomes of TLTG with functional end-to-end esophagojejunostomy.

Methods

We assessed the intraoperative and postoperative outcomes of 65 consecutive patients who underwent TLTG with functional end-to-end esophagojejunostomy at Tonan Hospital between January 2006 and August 2011.

Results

The mean surgical duration was 271.5?±?64.7 min, and the mean blood loss was 85.2?±?143.2 g. One patient (1.5 %) was converted to open surgery, and two patients (3.1 %) required reoperation due to ileus because of an internal hernia and jejunojejunostomy leakage. No reoperation was associated with functional end-to-end esophagojejunostomy. The mean hospital stay was 21.4?±?13.5 days. Ten patients (15.4 %) developed postoperative complications, of which three (4.6 %) were anastomotic stenosis associated with functional end-to-end esophagojejunostomy. All of these were resolved by endoscopic dilation.

Conclusion

Functional end-to-end esophagojejunostomy in TLTG is safe and feasible.     

Gas emission during laparoscopic colorectal surgery using a bipolar vessel sealing device: A pilot study on four patients

Background  

Dissection during laparoscopic surgery produces smoke containing potentially toxic substances. The aim of the present study was to analyze smoke samples produced during laparoscopic colon surgery using a bipolar vessel sealing device (LigaSure™).     

全腹腔镜全胃切除腔内消化道重建术式研究进展

随着腹腔镜器械的改进及外科腔镜下技术的提高,腹部微创手术得到快速发展,腹腔镜胃癌手术也正逐渐走向成熟。对于胃上部癌、胃体癌、皮革胃患者来说,全腹腔镜全胃切除术(TLTG)作为一种微创术式被广泛应用于临床,更小的手术创伤使患者更快的康复,明显提高了患者围手术期生活质量,已成为治疗胃癌,特别是早期可切除胃癌的主要方式之一。TLTG的技术要点和难点是如何在全腹腔镜视野下完成消化道重建,全腔镜下食管空肠吻合是TLTG消化道重建的难点,因此探讨TLTG消化道重建方式成为临床工作者的研究重点。本文就TLTG消化道常见术式作一综述,以期更好地为临床术式选择提供参考。     

New dog, new tricks: trends in performance on the Fundamentals of Laparoscopic Surgery simulator for incoming surgery residents

Background  

Exposure to laparoscopic surgery during medical school has increased over recent years. The Fundamentals of Laparoscopic Surgery (FLS) simulator allows for objective assessment of laparoscopic skills. This study aimed to determine whether the fundamental laparoscopic skills of incoming surgery residents have improved.     

Three-Step Esophagojejunal Anastomosis with Atraumatic Anvil Insertion Technique After Laparoscopic Total Gastrectomy

Background  

Esophagojejunostomy during laparoscopic total gastrectomy (LATG) using a circular stapler is a difficult procedure for which there remains no widely accepted standard technique. Based upon our experience with esophagogastrostomy during laparoscopic proximal gastrectomy, we have applied a modified lift-up method to LATG.     

Cholecystectomy Concomitant with Laparoscopic Gastric Bypass: A Trend Analysis of the Nationwide Inpatient Sample from 2001 to 2008

Background  

Gallstone formation is common in obese patients, particularly during rapid weight loss. Whether a concomitant cholecystectomy should be performed during laparoscopic gastric bypass surgery is still contentious. We aimed to analyze trends in concomitant cholecystectomy and laparoscopic gastric bypass surgery (2001–2008), to identify factors associated with concomitant cholecystectomy, and to compare short-term outcomes after laparoscopic gastric bypass with and without concomitant cholecystectomy.     

The effectiveness of adjustable gastric banding: a retrospective 6-year U.S. follow-up study

Background  

This study aimed to assess the efficacy of laparoscopic adjustable gastric banding (LAGB) during a 6-year follow-up period.     

Effects of additional laparoscopic cholecystectomy on outcomes of laparoscopic gastrectomy in patients with gastric cancer based on a national administrative database

Background

Little information is available on the effects of adding laparoscopic cholecystectomy to laparoscopic gastrectomy on outcomes of patients with gastric cancer. The aim of this study is to investigate the effects of adding laparoscopic cholecystectomy to laparoscopic gastrectomy on outcomes in patients with gastric cancer using a national administrative database.

Methods

A total of 14,006 patients treated with laparoscopic gastrectomy for gastric cancer were referred to 744 hospitals in Japan between 2009 and 2011. Patients were divided into two groups, those who also underwent simultaneous laparoscopic cholecystectomy for gallbladder stones (n = 1484) and those who underwent laparoscopic gastrectomy alone (n = 12,522). Laparoscopy-related complications, in-hospital mortality, length of stay, and medical costs during hospitalization were compared in the patient groups.

Results

Multiple logistic regression analysis revealed that adding laparoscopic cholecystectomy did not affect laparoscopy-related complications (odds ratio, 1.02; 95% confidence interval [CI], 0.84–1.24; P = 0.788) or in-hospital mortality (odds ratio, 1.16; 95% CI, 0.49–2.76; P = 0.727). Multiple linear regression analysis also showed that adding laparoscopic cholecystectomy did not affect the length of stay (unstandardized coefficient, 0.37 d; 95% CI, −0.47 to 1.22 d; P = 0.389). However, adding laparoscopic cholecystectomy was associated with significantly increased medical costs during hospitalization (unstandardized coefficient, $1256.0 (95% CI, $806.2–$1705.9; P < 0.001).

Conclusions

This study demonstrated that adding laparoscopic cholecystectomy did not affect outcomes of patients undergoing laparoscopic gastrectomy for gastric cancer, although medical costs during hospitalization were significantly increased.     

Safety Measures During Cholecystectomy: Results of a Nationwide Survey

Background  

This study aimed to identify safety measures practiced by Dutch surgeons during laparoscopic cholecystectomy.     

Is Routine Cholecystectomy Justified in Severely Obese Patients Undergoing a Laparoscopic Roux-en-Y Gastric Bypass Procedure? A Comparative Cohort Study

Background  

The aim of the present study was to evaluate the risks and benefits of concurrent prophylactic cholecystectomy (CPC) during laparoscopic Roux-en-Y gastric bypass (LRYGB).     

Influence of Laparoscopic Gastrectomy on the Detection Rate of Free Gastric Cancer Cells in the Peritoneal Cavity

Background  

Whether laparoscopic gastrectomy affects the number of gastric cancer cells exfoliated from the cancer-invaded serosa remains unclear. This study aimed to compare the detection rate of free gastric cancer cells in the peritoneal cavity during laparoscopic and open gastrectomy.     

Gut oxygenation and oxidative damage during and after laparoscopic and open left-sided colon resection: a prospective, randomized, controlled clinical trial

Background  

Pneumoperitoneum (PP), established for laparoscopic (LPS) operation, has been associated with potential detrimental effects, such as mesenteric ischemia–reperfusion injury. The objective of the trial was to measure intestinal tissue oxygen pressure (P_tiO₂) and oxidative damage during laparoscopic (LPS) and open colon surgery and during the postoperative course.     

Does hypocapnia before and during carbon dioxide insufflation attenuate the hemodynamic changes during laparoscopic cholecystectomy?

Background  

Hypocapnia before and during carbon dioxide (CO₂) insufflation for laparoscopic cholecystectomy may reduce the adverse hemodynamic responses.     

Laparoscopy: a safe approach to appendicitis during pregnancy

Background  

The aim of this study was to evaluate laparoscopic versus open surgery for suspected appendicitis during pregnancy.     

Effects of intraoperative breaks on mental and somatic operator fatigue: a randomized clinical trial

Background  

Intermittent work breaks are common in fields with high workload but not yet for surgeons during operations. We evaluated the effects of intraoperative breaks during complex laparoscopic surgery (5 min every half hour) on the surgeon.     

The effects of high-frequency jet ventilation (HFJV) on pneumoperitoneum-induced cardiovascular changes during laparoscopic surgery

Background  

Standard mechanical ventilation may cause adverse cardiovascular effects in addition to those already related to positive-pressure pneumoperitoneum (PP) during laparoscopic surgery. High-frequency jet ventilation (HFJV) is associated with much less airway pressure, with potentially less influence on venous return, thus potentially it may reduce those effects. The aim of this study was to evaluate the benefits of HFJV to reduce the adverse cardiovascular effects during laparoscopic cholecystectomy.     

No need for systemic heparinization during laparoscopic donor nephrectomy with short warm ischemia time

Purpose  

Systemic heparin administration during laparoscopic donor nephrectomy (LDN) may prevent microvascular thrombus formation following warm ischemia. We herein present our experience with and without systemic heparinization during LDN.     

Changes in cuff pressure of endotracheal tube during laparoscopic and open abdominal surgery

Background  

The purpose of this study was to investigate endotracheal tube cuff pressure alteration in patients during laparoscopic cholecystectomy surgery.