Journal of Surgical Innovation and Education

How I Do It

Laparoscopic Paraaortic Lymph Node Sampling in Gastric Cancer Patients with Suspected Paraaortic Lymph Node Metastasis: Ba Ool Seong, Ju No Yoo, Chang Seok Ko, Sa-Hong Min, Chung Sik Gong, In-Seob Lee, Moon-Won Yoo, Jeong Hwan Yook, Beom Su Kim; J Surg Innov Educ. 2024;1(2):34-38. Published online December 27, 2024; DOI: https://doi.org/10.69474/jsie.2024.00206

Abstract PDF: D2 lymphadenectomy is the standard approach for lymph node dissection in curable gastric cancer. However, paraaortic lymph node (PALN) dissection in addition to D2 lymphadenectomy has not been shown to improve survival rates and is therefore not routinely performed. Nevertheless, PALN sampling may be indicated for diagnostic purposes because it can provide critical information for accurate staging and treatment planning. Laparoscopic PALN sampling, however, poses significant challenges due to limited accessibility and visibility in the paraaortic region. Moreover, the proximity of major blood vessels, such as the abdominal aorta and renal vein, is another difficult aspect of the procedure. In this context, we present two cases to demonstrate practical strategies for facilitating laparoscopic PALN sampling. The procedure can be effectively performed by first identifying the ligament of Treitz and then, when necessary, fixing the small bowel mesentery to the abdominal wall using a tagging suture so that there is adequate vision and enough working space. This enables careful and precise dissection of the target tissue without compromising the feasibility and safety of the operation.

Laparoscopic Sleeve Gastrectomy: Ensuring Safety and Achieving an Aesthetic Gastric Tube Shape: Ba Ool Seong, Chang Seok Ko, Seul-Gi Oh, Seong-A Jeong, Jeoung Hwan Yook, Moon-Won Yoo, Beom Su Kim, In-Seob Lee, Chung Sik Gong, Sa-Hong Min; J Surg Innov Educ. 2024;1(1):22-25. Published online June 25, 2024; DOI: https://doi.org/10.69474/jsie.2024.00017

Abstract PDF: Sleeve gastrectomy was first performed in Korea in the 2000s, and its frequency has gradually increased thereafter. It is now the most commonly performed procedure for bariatric surgery today. However, there are few detailed reports on this surgical method, and, in particular, no papers that include accompanying videos. Herein, we present the case of a 29-year-old male with a preoperative body mass index of 44 kg/m2, who also had hypertension and hyperlipidemia. A conventional laparoscopic sleeve gastrectomy was performed using a 5-port technique. The surgeon employed two methods to ensure a consistent and aesthetic gastric tube, as well as patient safety: the non-tension method and a Lembert suture on the staple line at the neo–greater curvature. By utilizing the aforementioned two tips effectively, even inexperienced surgeons can perform laparoscopic sleeve gastrectomy relatively safely and effectively.

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