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

Comparative studies were made mainly on malignant cases of cholelithiasis in 111 patients with gallstones detected in our regular chekup (group A) during the five-year period from 1985 to 1989 and 67 patients who had gallstones surgically removed together with malignancies (group B) during the same period.
The group A patients representing 4.2% of the total 2, 637 examinees were suspected to suffer from biliary obstruction and malignant tumors involving the digestive system. However, further examination found only one case of biliary tract cancer.
The group B patients account for 20.9% of the total 321 surgery cases. In 37 (55.2%) of the 67 patients, 45 legions were malignant-mostly cancer in the digestive organs. Cancer of the lower portion of the digestive tract was found in 11 patients (29.7%) of the 37. The occult blood test at hospitalization revealed that 8 patients (28.6%) in 28 were positive, and 9 were not clear. Follow-up examination showed the rate of false-positive reaction to blood test stood at 14.3%.
From the foregoing results, to detect cancer of the large intestine at an early stage in the regular medical checkup sponsored by the agricultural cooperative, the occult blood test using the stool of examines alone is not enough. It is high time to introduce endoscopic examinationinto the screening program. In view of the fact that most of the gallstone cases detected at the regular checkup were symptomless, careful followup examinations are deemed necessary with the possibleonset of gallbladder cancer and presence of malignancies in mind.