Feasibility and safety of laparoscopic purse-string suture clamps and multi-functional seal caps for total laparoscopic radical total gastrectomy
10.3760/cma.j.cn441530-20250218-00064
- VernacularTitle:腔镜下荷包钳及多功能密封圈在全腔镜根治性全胃切除术中应用的可行性及安全性分析
- Author:
Yawei QIAN
1
;
Zhongyuan HE
1
;
Fengyuan LI
1
;
Pengyu LI
1
;
Weizhi WANG
1
;
Linjun WANG
1
;
Diancai ZHANG
1
;
Hao XU
1
;
Zekuan XU
1
;
Li YANG
1
Author Information
1. 南京医科大学第一附属医院胃肿瘤中心，南京 210029
- Publication Type:Journal Article
- Keywords:
Stomach neoplasms;
Laparoscopic purse-string suture clamp;
Multi- functional seal cap;
Circular stapler;
Oesophagojejunostomy
- From:
Chinese Journal of Gastrointestinal Surgery
2025;28(8):908-915
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the feasibility and safety of laparoscopic purse- string suture clamps combined with multi-functional seal caps for esophagojejunal Roux-en-Y anastomosis during total laparoscopic radical total gastrectomy (TLTG).Methods:This was a retrospective descriptive study of 42 patients with primary gastric malignancies who underwent TLTG at the First Affiliated Hospital of Nanjing Medical University that utilized laparoscopic purse-string suture clamps and multi-functional seal caps for esophagojejunal anastomosis between May, 2024 and January, 2025. The cohort included 33 males and 9 females, with a mean age of (67.7 ±9.5) years and a mean body mass index (BMI) of (23.9±2.9) kg/m 2. The American Society of Anesthesiologists (ASA) physical status classifications were I - II in 40 patients and III in 2 patients, and all patients were definitively diagnosed preoperatively via gastroscopy, dual-energy CT, and/or MRI. Tumor locations included the gastroesophageal junction (GEJ) in 28 cases (Siewert type II - III), the upper third of the stomach in 12 cases, and the middle third in 2 cases. The median distance of esophageal invasion was 1.3 cm, though in 10 cases this was ≥2 cm. Preoperative TNM staging was I-II in 17 patients and III in 25 patients. Surgical outcomes including operative time, anastomosis time, intraoperative blood loss, pathological results, and postoperative recovery were retrospectively analyzed. Results:All 42 operations were successful. The mean operative time was(212.5±26.4) minutes, and the average time from multi-functional seal cap placement to completion of the esophagojejunal anastomosis was (54.2±7.5) minutes. Mean intraoperative blood loss was (79.9±21.3) ml. Postoperative pathology confirmed R0 resection in all specimens, with a mean proximal esophageal margin distance of (2.1±1.6) cm. Furthermore, (51.9±15.1) lymph nodes on average were harvested from each patient; the mean time to oral intake was (149.5±41.4) hours; and the mean hospital stay was (11.3±5.4) days. Postoperative complications occurred in 6 patients: anastomotic leakage ( n=2), residual intra-abdominal infection ( n=1), pulmonary infection ( n=3), and Clavien-Dindo grade III or higher complications occurred in 2 patients. No recurrence, mortality, or anastomosis-related complications were observed within a median follow-up of 5.8 months (range 3.5-11.2). Conclusion:We find the application of the laparoscopic purse-string suture clamps and multi-functional seal caps for esophagojejunal anastomosis in TLTG to be safe and feasible, with satisfactory short-term outcomes.
