A Case of Total Gastrectomy with Hand-assisted Laparoscopic Surgery (HALS) for the Patient with Early Gastric Cancer.
10.2185/jjrm.50.54
- VernacularTitle:早期胃癌に対するＨＡＬＳ（ｈａｎｄ ａｓｓｉｓｔｅｄ ｌａｐａｒｏｓｃｏｐｉｃ ｓｕｒｇｅｒｙ）下胃全摘術の１例
- Author:
Isao KAWAMURA
;
Kazuma YAMAZAKI
;
Masaaki KODAMA
;
Okamichi MORIKAWA
;
Kentaro KANEKO
;
Koji TOBITA
;
Daisuke HORIBE
;
Masakazu HASEGAWA
;
Yasushi AKAIKE
- Publication Type:Journal Article
- Keywords:
hand assisted laparoscopic surgery
- From:Journal of the Japanese Association of Rural Medicine
2001;50(1):54-60
- CountryJapan
- Language:Japanese
-
Abstract:
The patient was a 63-years-old female with early gastric cancer in her upper stomach. Widely spreading on the mucous membrane, the cancer was too big to remove by endoscopical mucosal resection, although she wanted minimal invasive treatment. Therefore, we adopted total gastrectomy with hand-assisted laparoscopic surgery (HALS) after obtaining “informed consent” from her. Five small skin-incisions were necessary to perform it-one 7cm' for hand-port and four 1.2cm' for trocars.
The dissection was started from greater omentum and proceeded counterclockwise to remove primary lymphnodes. The abdominal esophagus and the duodenum were devided with a single or double application of Endo GIA stapler (linear stapler). All these steps were accomplished safely and securely with the effective support of the left hand of the operator. After extraction of the whole stomach through the 7cm-incision, Roux-en Y reconstruction was performed laparoscopically (esophago-jejunostomy) followed by hand sewing through the 7cm-incision (jejuno-jejunostomy). The anvil of 21mm circular stapler (EEA) was inserted orally in order to anastomose the esophagus to the jejunum. The patient had acceptable results intra-operatively as well as postoperatively by HALS total gastrectomy, which had been considered to be very hard to perform up to present time.
