上部胃癌に対する胃上部郭清を先行した腹腔鏡下胃切除術の定型化

Abstract

In the present report, we show the standardizing laparoscopic procedure for proximal early gastric cancer, in which the dissection of upper portion of the stomach precedes the transection of duodenum or distal side of the stomach. First, the lesser omentum is opened toward the esophagus, and the right side of abdominal esophagus and the right crus of diaphragm are exposed. Then, the greater omentum is opened, and the left gastroepiploic vessels are divided. In the same view, the short gastric vessels are continued to dividing and the left side of the abdominal esophagus is exposed. Next, the pancreatic capsule is dissected along the common hepatic artery and splenic artery. Lymph node dissection of station No. 8a, 9, 11p can be achieved. The left gastric artery is divided with preservation of the celiac branch of the vagus nerve. Finally, the transection of the abdominal esophagus is performed. Consequently, the dissection of upper portion of the stomach is completed and the stomach is extracted from minilaparotomy. In case of total gastrectomy, the dissection of supra- and infrapyloric lymph nodes and the transection of duodenum lastly performed. The standardization of dissecting procedure in laparoscopy-assisted total gastrectomy and function-preserving gastrectomy, including proximal gastrectomy and pylorus-preserving nearly total gastrectomy, has made possible the safety of laparoscopic surgery for proximal gastric cancer.