Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Dec;25(12):3928-9.
doi: 10.1007/s00464-011-1792-0. Epub 2011 Jun 10.

Video: laparoscopy distinctive technique for suprapancreatic lymph node dissection: medial approach for laparoscopic gastric cancer surgery

Seiichiro Kanaya  1 , Shusuke Haruta, Yuichiro Kawamura, Fumihiro Yoshimura, Kazuki Inaba, Yoshihiro Hiramatsu, Yoshinori Ishida, Keizo Taniguchi, Jun Isogaki, Ichiro Uyama
Affiliations

Video: laparoscopy distinctive technique for suprapancreatic lymph node dissection: medial approach for laparoscopic gastric cancer surgery

Seiichiro Kanaya et al. Surg Endosc. 2011 Dec.

Abstract

Background: Suprapancreatic lymph node (LN) dissection is critical for gastric cancer surgery. Until currently, a number of laparoscopic gastrectomy procedures have been performed in the same manner as open surgery procedures [3, 4, 6]. Using the characteristic of laparoscopic surgery, the authors developed a new technique of suprapancreatic LN dissection.

Methods: After division of the duodenum, No. 8a LN is raised, and the surrounding tissue is dissected to identify the outmost layer of the nerves around the common hepatic artery. This layer can be dissected as the next step is headed for the root of the left gastric artery. Thin layers can be identified on the left and right sides of the artery. After this step, the LN dissection is performed toward both lateral sites, keeping the outmost layer of the nerves. At this stage, the surgeon should envision the "U" shape on the right side and the "V" shape on the left side for a superior performance. This technique was performed by the same surgeon for 20 consecutive patients with advanced gastric cancer.

Results: All the patients successfully underwent laparoscopic distal gastrectomy with D2 LN dissection. The mean number of regional LNs retrieved was 45.1 ± 13.5. The mean number of only LNs around the celiac artery (No. 7, 8a, 9, 11p, and 12a) was 17.8 ± 5.5. This was not less than reported previously [1, 2, 5]. The mean blood loss was 91.1 ml, and the mean operative time was 296.0 min. At this writing, all the patients are disease free after a mean follow-up period of 15.4 months.

Conclusions: The nerves are thick and sturdy around the root of the left gastric artery. Additionally, the magnified and horizontal laparoscope view provides a straightforward approach and visibility to the layer. The authors believe that the "medial approach" is a straightforward method of suprapancreatic LN dissection in laparoscopic gastric cancer surgery.

PubMed Disclaimer

References

    1. Ann Surg Oncol. 2007 Nov;14(11):3148-53 - PubMed
    1. J Am Coll Surg. 2004 Jun;198(6):933-8 - PubMed
    1. Surg Endosc. 2008 Mar;22(3):655-9 - PubMed
    1. Surg Endosc. 2009 Feb;23(2):436-7 - PubMed
    1. Surg Endosc. 2005 Dec;19(12):1592-6 - PubMed

LinkOut - more resources