机器人根治性远端胃次全切除术

术中在横结肠上缘切开胃结肠韧带,将横结肠系膜前叶分离,向右分离,显露胃网膜右动脉由胰十二指肠动脉分支根部并离断,清除周围淋巴结。将胃翻向上方,在胰腺上缘肝总动脉之起始部找到胃左动脉。分别显露胃左动脉和静脉。先切断静脉,再切断胃左动脉,剥离胰腺背膜,并切除周围脂肪,清除肝总动脉及胰腺上缘之淋巴结,向右继续清除幽门上淋巴结群。在胃十二指肠动脉分出胃右动脉处切断胃右动脉,清除肝固有动脉周围之淋巴结,离断十二指肠。向右继续清除脾动脉周围之淋巴结及脂肪组织,将胃向上翻起,清除贲门淋巴结及脂肪组织。余步骤辅助小切口完成胃肠Roux-en-Y重建。

Robotic radical distal subtotal gastrectomy for gastric cancer

In this surgery, firstly gastrocolic ligament was dissected along the transverse colon from left to right side, and the anterior transverse mesocolon was separated, and was expanded to the right side.To expose and cut right gastroepiploic artery at the root of pancreaticoduodenal branch artery , and to clean the NO.6 lymph nodes.Then to lift the stomach upward, and to dissect left gastric artery at the beginning of common hepatic artery above superior border of the pancreas.To expose the left gastric vein and artery separately, and to cut vein firstly then to cut artery.To separate the serum of pancreas and to clean adipose tissue, to dissect the lymphatic tissue around common hepatic artery and superior border of the pancreas , and further to clean the NO.5 lymph nodes.To cut the right gastric artery at its root from gastroduodenal artery , and to clean the lymphatic tissue around proper hepatic artery, then to cut the duodenum.Continue to clean the lymphatic adipose tissue around splenic artery, and lift the stomach, clean the cardiac lymph nodes.The rest of steps were similar with standard Roux-en-Y reconstruction which was performed through a minor abdominal incision .