Laparoscopy-assisted distal gastrectomy (LADG) has been advocated as a minimally invasive operation for early gastric cancer which needs regional lymph node resection. However, since it is technically too complicated and difficult to perform all laparoscopic procedures within the abdominal cavity, LADG has not become the standard surgical procedure for early gastric cancer. Moreover, a skin incision of approximately 5cm is required to allow the reconstruction of the digestive tract after gastrectomy. Therefore, we have developed an operative procedure which we call hand-assisted laparoscopic distal gastrectomy (HALDG). In this procedure we make a skin incision of 6cm, and the surgeon inserts his/her left hand into the abdomen to assist the laparoscopic procedure. The surgeon can move his/her left hand freely, to palpate and explore the organs, as in an open surgery. Therefore, the operation time can be shortened. Our results thus far obtained demonstrated that HALDG was as safe and effective as open distal gastrectomy. HALDG assures the patients a better quality of life, --less surgical trauma, less pain, speedy return to dialy life activities. Thus, it is beneficial to the patients with early gastric cancer. We, therefore, advocate the use of HALDG in such cases.
Gastrectomy ; Stomach Cancer ; Hand ; Procedures ; Pulmonary evaluation

In recent years, plain X-ray CT has often been the first choice for imaging examination of acute abdomen in emergency medical settings. Ultrasound examination depends on the skill of the operator and the findings are subjective. However, we often experience cases in which more information can be obtained by abdominal ultrasonography than by plain CT. In this report, we describe two cases in which ultrasonography and plain CT imaging were performed in patients with right lower abdominal pain due to suspected abscess formation around the cecum. In the future, policies to reduce medical costs such as community healthcare initiatives may progress, and the number of facilities with high-priced medical equipment such as X-ray CT may decrease. Ultrasonography provides more information than simple CT examination, so we believe that ultrasonography should be the first choice for diagnostic imaging of acute abdomen. Therefore, it is important for those involved in ultrasonography to continuously acquire knowledge and scanning techniques.