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Laparoscopic Pylorus Preserving Gastrectomy with Intra-Corporeal Gastro-Gastrostomy Guided by Intra-Operative Gastroscopy

Laparoscopic Pylorus Preserving Gastrectomy

Article information

J Surg Innov Educ. 2024;1(1):28-29
Publication date (electronic) : 2024 June 25
doi : https://doi.org/10.69474/jsie.2024.00059
Mohd Firdaus Che Ani1,3orcid_icon, Zhuang Chun1,4orcid_icon, Abdullah Almayouf1, Jee-sun Kim1,2orcid_icon, Seong-Ho Kong1,2orcid_icon, Do-Joong Park1,2orcid_icon, Han-Kwang Yang1,2orcid_icon, Hyuk-Joon Lee,1,2orcid_icon
1Division of Gastrointestinal Surgery, Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
2Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
3Department of Surgery, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
4Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Corresponding author: Hyuk-Joon Lee, MD, PhD Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine; Division of Gastrointestinal Surgery, Seoul National University Hospital; Gastric Cancer Center, Seoul National University Cancer Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea Tel: +82-2-2072-1957, E-mail: appe98@snu.ac.kr
Received 2024 June 3; Revised 2024 June 19; Accepted 2024 June 19.

Abstract

Gastric cancer detection is advancing to a point where screening programs can detect gastric cancer at early stages. This allows surgical procedures to be less radical than before. Studies have proven that pylorus preserving gastrectomy is a safe procedure in early T1a and T1b gastric cancers where the tumour location is in the middle third of the stomach. However, due to the small tumour size, determining an appropriate resection margin can be challenging. A few techniques have been developed to overcome this difficulty, and at our centre, we perform intra-operative gastroscopy to synchronize with the laparoscopic view and precisely determine the tumour location for optimal gastric resections. This allows the gastrectomy to be performed safely and prevents inadequate resection leaving tumour cells behind. This video is aimed at sharing our experience in performing pylorus-preserving gastrectomy.

Chapter Summary

00:00:01 Introduction

00:00:10 Case summary

00:00:23 Radiology: X-ray

00:00:30 Radiology: staging CT scan (snapshot)

00:00:38 Schematic diagram for PPG (gastric resection & lymph node dissection)

00:00:45 Laparoscopic assessment and liver retraction

00:00:51 Marking of important anatomical landmarks

00:01:16 Beginning of dissection over greater curvature: partial omentectomy

00:01:44 Intra-operative gastroscopy

00:02:45 Take down of the left gastro-epiploic vessels

00:03:32 Dissection of intra-pyloric region

00:04:35 Infra-pyloric artery preservation and right gastro epiploic vessel dissection

00:06:37 Supra-pyloric dissection

00:07:16 Distal gastric transection

00:07:57 Take-down of the left gastric artery and vein pedicle

00:08:45 Dissection of proximal lesser curvature

00:09:13 Proximal gastric transection

00:09:39 Gastro-gastrostomy reconstruction

00:12:48 Irrigation of the peritoneal cavity

00:12:53 Resected gastric specimen

00:12:58 Final pathology report

Notes

Disclosure

Hyuk-Joon Lee is the president of the Korean Surgical Skill Study Group and Seong-Ho Kong is an editorial board member of the journal, but they were not involved in the peer reviewer selection, evaluation, or decision process of this article. No other potential conflicts of interest relevant to this article were reported.

References

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2. Sun KK, Wu YY. Pylorus-preserving gastrectomy for early gastric cancer. World J Gastrointest Oncol 2024;16:653–658.
3. Kong SH, Kim JW, Lee HJ, Kim WH, Lee KU, Yang HK. The safety of the dissection of lymph node stations 5 and 6 in pylorus-preserving gastrectomy. Ann Surg Oncol 2009;16:3252–3258.
4. Park DJ, Kim YW, Yang HK, Ryu KW, Han SU, Kim HH, et al. Short-term outcomes of a multicentre randomized clinical trial comparing laparoscopic pylorus-preserving gastrectomy with laparoscopic distal gastrectomy for gastric cancer (the KLASS-04 trial). Br J Surg 2021;108:1043–1049.
5. Xia X, Xu J, Zhu C, Cao H, Yu F, Zhao G. Objective evaluation of clinical outcomes of laparoscopy-assisted pylorus-preserving gastrectomy for middle-third early gastric cancer. BMC Cancer 2019;19:481.
6. Japanese Gastric Cancer Association. Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition). Gastric Cancer 2023;26:1–25.
7. Kim TH, Kim IH, Kang SJ, Choi M, Kim BH, Eom BW, et al. Korean practice guidelines for gastric cancer 2022: an evidence-based, multidisciplinary approach. J Gastric Cancer 2023;23:3–106.

Article information Continued

© 2024 Korean Surgical Skill Study Group

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.