Single Incision Plus One Port Laparoscopic Proximal Gastrectomy with Double Channel Anastomosis for Gastric Cancer Treatment
December 27th, 2024
The single-incision plus one-port laparoscopic proximal gastrectomy with double-channel anastomosis was initially employed for the radical resection of proximal gastric cancer. This study demonstrated the feasibility of the procedure and laid a foundation for further research.
After endotracheal intubation and administering general anesthesia, a transverse incision measuring 3 to 3.5 centimeters was created around the navel to insert the SILS port equipped with four in-built trocars. An additional 12-millimeter trocar was inserted in the left upper quadrant to serve as an operative port for surgical instruments. The ultrasonic knife was used to dissect the adipose lymphoid tissue of groups 1, 2, 3, 4, 7, 8a, 9, and 11p.
A lower esophageal segment length of approximately 5 to 7 centimeters was ensured while maintaining the freedom of the greater and lesser curvatures of the stomach. The esophagus-jejunum or EJ anastomosis was identified on the jejunum, located 20 centimeters distal to the ligament of Treitz and near the lower esophagus. A 60-millimeter endoscopic linear stapler was used to create the EJ anastomosis through the 12-millimeter port in the left upper quadrant.
Next, a 60-millimeter endoscopic linear stapler was used to resect specimens of the esophagus and to close the anastomotic opening between the jejunum and esophagus. The gastrojejunal or GJ anastomosis was created with the site marked on the jejunum 8 to 15 centimeters distal to the EJ anastomosis and on the posterior wall of the greater curvature of the remaining stomach. Next, the jejunojejunal anastomosis was established using a 60-millimeter endoscopic linear stapler through the 3.5 centimeter incision at the navel, marking 5 centimeters distal to the GJ anastomosis site.
The individual anastomosis were closed and strengthened. Both the common openings of the GJ and jejunojejunal anastomosis were closed using a 3-0 micro Joe thread. Then, the mesangial hiatus was closed with a continuous suture.
At the end of the procedure, a drainage tube was placed behind the EJ anastomosis and exited through the left upper abdomen. The surgery was completed in 150 minutes with minimal interoperative bleeding of 5 milliliters and no complications reported postoperatively while 24 lymph nodes were retrieved with no metastasis detected. The patients recovery involved bed rest for two days.
The first flatus occurred at 70 hours postoperatively. And oral intake of liquid food began on the third day. The gastric tube was removed on day four, and the drainage tube was removed within seven days, showing efficient recovery milestones.
Upper gastrointestinal radiography revealed contrast agent retention in the remnant stomach for 30 to 50 minutes with no evidence of esophageal reflux. The cosmetic outcome of the postoperative abdominal incisions was satisfactory with minimal scarring evident.
Overview
This study explores the single-incision plus one-port laparoscopic proximal gastrectomy with double-channel anastomosis for radical resection of proximal gastric cancer. The findings demonstrate the feasibility of the procedure and provide a foundation for future research.
Key Study Components
Area of Science
- Surgery
- Oncology
- Gastroenterology
Background
- Proximal gastric cancer requires effective surgical intervention.
- Traditional methods may involve larger incisions and longer recovery times.
- Minimally invasive techniques aim to reduce patient trauma and improve recovery.
- This study focuses on a novel surgical approach to enhance outcomes.
Purpose of Study
- To evaluate the feasibility of a single-incision laparoscopic technique.
- To assess the effectiveness of double-channel anastomosis in surgical outcomes.
- To provide insights for future research in laparoscopic surgery for gastric cancer.
Methods Used
- General anesthesia was administered to the patient.
- A transverse incision was made around the navel to insert a SILS port.
- Ultrasonic knife was utilized for dissection of lymphoid tissues.
- Anastomoses were created using endoscopic linear staplers through minimal incisions.
Main Results
- The surgery was completed in 150 minutes with minimal bleeding.
- No complications were reported postoperatively.
- 24 lymph nodes were retrieved with no metastasis detected.
- Patients showed efficient recovery milestones with satisfactory cosmetic outcomes.
Conclusions
- The single-incision laparoscopic technique is feasible for proximal gastrectomy.
- Double-channel anastomosis can be effectively performed with minimal complications.
- This approach may enhance recovery and reduce scarring in patients.
Frequently Asked Questions
Executive Industry Relevance
Minimally invasive surgical innovations such as single-incision plus one-port laparoscopic proximal gastrectomy with double-channel anastomosis (SILT-DT) address the need for reduced patient trauma and faster recovery in gastric cancer management. For biopharma R&D, these advances inform the development of disease-relevant preclinical models and support translational research on surgical outcomes and tissue response. The integration of precise lymph node dissection and quantitative recovery metrics enhances predictive confidence for downstream therapeutic and biomarker studies.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables collection of high-quality, well-characterized gastric and lymphoid tissue for molecular analysis.
- Supports functional validation of surgical and perioperative biomarkers in disease-relevant systems.
- Facilitates mechanistic de-risking by correlating surgical intervention with biological endpoints.
Screening & Assay Development
- Provides standardized tissue samples for assay development and validation workflows.
- Improves reproducibility of quantitative outputs such as lymph node yield and recovery milestones.
- Enables reliable evaluation of perioperative pharmacological interventions in controlled settings.
Translational & Preclinical Research
- Aligns surgical models with clinical scenarios for translational biomarker discovery.
- Supports continuity from surgical intervention to preclinical validation of therapeutic strategies.
- Enables risk-adjusted advancement decisions based on quantitative recovery and complication data.
Pipeline & Workflow Integration
SILT-DT positions as a bridge between surgical innovation and translational research, supporting workflows from tissue acquisition to preclinical model development.
- Discovery Biology: Enables hypothesis testing on surgical impact and tissue response in gastric cancer.
- Screening: Standardizes sample collection for downstream molecular and cellular assays.
- Analytics: Provides quantitative metrics such as lymph node count, recovery time, and complication rates for comparative analysis.
- Translational Research: Facilitates alignment of surgical models with clinical endpoints for biomarker validation.
- Enterprise Reuse: Establishes a reproducible surgical protocol adaptable across research sites and studies.
Operational & Enterprise Impact
- Scientific Value: Enhances predictive confidence and target validation through standardized surgical and recovery metrics.
- Operational Value: Improves reproducibility, scalability, and standardization of tissue acquisition and perioperative data.
- Strategic Value: Informs go/no-go decisions for translational research and perioperative intervention studies.
- Portfolio Impact: Supports risk-adjusted prioritization of surgical and therapeutic research programs.
Implementation Considerations
- Requires surgical expertise in minimally invasive and laparoscopic techniques.
- Demands access to advanced instrumentation such as SILS ports and endoscopic staplers.
- Necessitates cross-team standardization for tissue handling and data collection.
- Adaptation may be needed for different tumor locations or patient profiles.
- Recovery and complication metrics must be consistently tracked for reliable integration into research workflows.
