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01-04-2018 | Dynamic Manuscript

Outermost layer-oriented medial approach for infrapyloric nodal dissection in laparoscopic distal gastrectomy

Authors: Susumu Shibasaki, Koichi Suda, Masaya Nakauchi, Tetsuya Nakamura, Shinichi Kadoya, Kenji Kikuchi, Kazuki Inaba, Ichiro Uyama

Published in: Surgical Endoscopy | Issue 4/2018

Abstract

Background

Based on our experience of suprapancreatic nodal dissection in laparoscopic gastrectomy, we developed an outermost layer-oriented medial approach for infrapyloric nodal dissection. The objective of this single-institution retrospective study was to determine the feasibility, safety, and reproducibility of this novel and unique dissection procedure.

Methods

This approach can be performed in the same manner as suprapancreatic nodal dissection but by replacing the left gastric artery with the right gastroepiploic artery (RGEA), the common hepatic artery with the anterior superior pancreaticoduodenal artery (ASPDA), and the splenic artery with the gastroduodenal artery. It comprises five steps: (1) mobilization of the transverse mesocolon along the prepancreatic membrane, (2) medial dissection along the dissectable layer between the pancreatic head and the dorsal side of the right gastroepiploic vein (RGEV), (3) division of the RGEV and determination of the lateral and cranial borders, (4) dissection along the outermost layer of the RGEA and ASPDA and transection of the infrapyloric artery and RGEA, and (5) transection of the duodenal bulb.

Results

This novel method was applied in 112 patients who underwent laparoscopic distal gastrectomy from 2014 to 2015. The anatomical landmarks that we determined to appropriately identify the outermost layer were highly reproducible, and our novel procedure based on these landmarks was successfully completed in all cases, without any intraoperative complications. Furthermore, in all cases, no. 6 lymph nodes were fully and adequately dissected within the infrapyloric area anatomically defined in the Japanese Classification of Gastric Carcinoma ver. 14. Pancreatic fistula occurred only in 1.8% cases.

Conclusions

This novel outermost layer-oriented medial approach is a robust procedure that may help laparoscopic surgeons in performing safe and reproducible infrapyloric nodal dissection.

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Title: Outermost layer-oriented medial approach for infrapyloric nodal dissection in laparoscopic distal gastrectomy
Authors: Susumu Shibasaki
Koichi Suda
Masaya Nakauchi
Tetsuya Nakamura
Shinichi Kadoya
Kenji Kikuchi
Kazuki Inaba
Ichiro Uyama
Publication date: 01-04-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 4/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-018-6111-6

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Outermost layer-oriented medial approach for infrapyloric nodal dissection in laparoscopic distal gastrectomy

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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