Yoshiyuki Komori

Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymphadenectomy for advanced gastric cancer

The standard lymph node dissection for advanced gastric cancer is a D2 dissection. Although D2 laparoscopy-assisted total gastrectomy with distal pancreatosplenectomy has been reported, no studies have reported a completely intra-abdominal laparoscopic approach, because of the technical difficulty of the procedure. We successfully performed this novel procedure in two patients with advanced gastric cancer located in the upper portion of the stomach. In fact, this surgery is technically feasible, and has a potential curability comparable with that of open surgery.

Completely laparoscopic extraperigastric lymph node dissection for gastric malignancies located in the middle or lower third of the stomach

Abstract:Dissection of the extraperigastric lymph nodes is necessary in most submucosal gastric cancers. Laparoscopy-assisted gastrectomy with extraperigastric lymph node dissection via minilaparotomy has been performed, but, to our knowledge, completely laparoscopic extraperigastric lymph node dissection has never been reported. We successfully performed completely laparoscopic distal gastrectomy with extraperigastric lymph node dissection in 12 patients, of whom 11 had early gastric cancer and 1 had malignant lymphoma. This surgery is technically feasible, has an acceptable complication rate, and a curability similar to that with open surgery.

Laparoscopic D2 lymph node dissection for advanced gastric cancer located in the middle or lower third portion of the stomach.

Abstract The standard lymph node dissection for advanced gastric cancer is a D2 dissection, performed in accordance with the new Japanese classification of gastric carcinoma (13th edition). Although laparoscopic D2 dissections according to the General rules for gastric cancer study (12th edition) have been reported, no studies have reported laparoscopic D2 dissections according to the revised classification for advanced gastric cancers located in the middle or lower portions of the stomach. The lack of such studies is due to the perceived technical difficulty of the procedure. However, we successfully performed this novel procedure in five patients with advanced gastric cancer located in the middle or lower portions of the stomach. In fact, this surgical procedure is technically feasible and safe.

Completely laparoscopic proximal gastrectomy with jejunal interposition and lymphadenectomy1

Proximal gastrectomy with gastroesophagostomy or jejunal interposition is being performed widely in Japan for early-stage gastric neoplasm in the upper portion of the stomach. Its frequent use is partially attributable to the improved postoperative fat absorption, nutrition, and release of gut hormones associated with the procedure as compared with total gastrectomy. Whether gastroesophagostomy or jejunal interposition should be selectively performed after proximal gastrectomy is a controversial matter of opinion. Although gastroesophagostomy is a simple, easy, and safe procedure, it results in a high incidence of reflux esophagitis. In this respect, jejunal or jejunal pouch interposition is superior to gastroesophagostomy as a followup procedure to proximal gastrectomy. Recently, to achieve less invasive surgery, laparoscopic distal partial gastrectomies have been performed. Although the laparoscopy-assisted proximal gastrectomy with gastroesophagostomy was previously reported, no studies have reported laparoscopic proximal gastrectomy with jejunal interposition. Such a lack of studies is likely caused by the procedure’s technical difficulty. We successfully performed completely laparoscopic proximal gastrectomy with jejunal interposition using a functional end to end anastomotic technique. We describe our new procedure and the initial clinical results in this article. METHODS

Linear stapling forms improved anastomoses during esophagojejunostomy after a total gastrectomy

BACKGROUND Circular stapling devices are commonly used to form esophagojejunal anastomoses after total gastrectomy. However, the technique has potential problems with placement of the purse-string suture and insertion of the anvil of the instrument. METHODS We describe an improved technique for esophagojejunostomy by functional end-to-end anastomosis with linear stapling devices. RESULTS Three patients with gastric cancer underwent this procedure after total gastrectomy. No anastomotic leakage or clinical evidence of stenosis was encountered. The maximum diameters of the anastomoses, evaluated by radiography with barium at 6 months after surgery, were 3.5 cm and 4.0 cm in 2 patients. Endoscopic examination revealed clear lines of anastomosis with a straight continuity between the distal esophagus and the jejunum. CONCLUSIONS Our improved technique for esophagojejunostomy by functional end-to-end anastomosis with two linear staplers is a convenient, safe and reliable procedure that is independent of the width of the esophagus and the depth of the esophageal hiatus.

Laparoscopic Right Hemicolectomy with Radical Lymph Node Dissection Using the No-Touch Isolation Technique for Advanced Colon Cancer

Abstract The treatment of advanced right-sided colon cancer presents numerous challenges for the surgeon who must aim to minimize the invasiveness of surgery, achieve curative resection, and prevent port-site recurrences. To overcome these issues, we performed a totally intra-abdominal laparoscopic right hemicolectomy with radical lymph node dissection based on a no-touch isolation technique. To perform this no-touch technique, we initially dissected the lymph nodes along the surgical trunk, then transected the transverse colon, terminal ileum, and mesentery without tumor manipulation. Finally, the right side of the colon was freed retroperitoneally. We performed this surgical technique on three patients and no intraoperative complications were encountered. Curative resection was achieved in all three patients, as curability A according to the Japanese Classification of Colorectal Carcinoma, and their postoperative courses were uneventful. Therefore, this novel technique proved to be both feasible and safe. Furthermore, it enabled us to minimize the invasiveness of surgery, while providing clear access to resect the right-sided advanced colon cancer.

Laparoscopy-assisted uncut Roux-en-Y operation after distal gastrectomy for gastric cancer

In order to prevent the Roux stasis syndrome that sometimes follows Roux-en-Y gastrojejunostomy after distal gastrectomy, a new type of reconstruction, called the uncut Roux-en-Y technique, has been reported. We successfully performed 42 laparoscopy-assisted uncut Roux-en-Y gastrojejunostomies. Here we describe our technique and the initial outcome.

Purely laparoscopic pylorus-preserving gastrectomy with extraperigastric lymphadenectomy for early gastric cancer: a case and technical report.

For the purpose of prevention of postgastrectomy syndrome and a less invasive and yet curative oncological resection, a purely laparoscopic pylorus-preserving gastrectomy with extraperigastric lymphadenectomy was performed for a patient with early gastric cancer located in the middle third of the stomach. The patients postoperative course was uneventful. During his postoperative recovery, the patient experienced very little pain and used analgesic medication only one time. This operation appeared to be oncologically adequate. As of the seventh postoperative month, the patient never experienced dumping syndrome or alkaline reflux gastritis. This procedure is technically feasible and an excellent option because of its reduced surgical invasiveness and better postoperative quality of life.

Laparoscopic lateral node dissection with autonomic nerve preservation for advanced lower rectal cancer

In Japan, radical resection with autonomic nerve preservation and lateral node dissection is standard surgery for advanced lower rectal cancers. But this operation has never been performed laparoscopically because many surgeons consider laparoscopic lateral node dissection with nerve preservation to be technically difficult, and any resulting insufficiency of the lateral lymph node dissection may reduce the curability of a patient’s cancer. Nonetheless, laparoscopic resection without lateral lymph node dissection is commonly performed for colorectal cancer to reduce the surgical invasiveness. Recently, we successfully performed laparoscopic radical resection with autonomic nerve preservation and lateral lymph node dissection in five patients with advanced lower rectal cancer. We describe here our surgical procedure and our initial clinical results.

Gastrointestinal stromal tumor of the stomach successfully treated by laparoscopic proximal gastrectomy with jejunal interposition.

The authors describe a patient with a bleeding gastrointestinal stromal tumor of the stomach who was treated successfully by laparoscopic proximal gastrectomy with jejunal interposition. Immunohistochemically, the tumor was positive for vimentin and CD34 and was diagnosed as a gastrointestinal stromal tumor of low-grade malignancy. Because it is difficult to diagnose this disease preoperatively and a malignant phenotype has been reported, resulting in liver metastasis and peritoneal dissemination, it is desirable to treat this disease with as little manipulation as possible. To achieve this, laparoscopic surgery is a feasible option for the treatment of gastrointestinal stromal tumors.