Hand-assisted Laparoscopic Total Gastrectomy

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Abstract
Although the standard method to manage gastric cancer is still radical gastrectomy, minimally invasive surgery is of great interest in early gastric cancer because of its potential impact on improving the quality of life, if the disease is curable. With its degree of technical difficulty, laparoscopic total gastrectomy has not yet met with widespread acceptance. However, using a hand-access device, a total gastrectomy and Roux-en-Y esophagojejunostomy with a D1 plus alpha lymph node dissection and omentectomy with an Ultrashear was performed in its entirety. The operation took 6 hours, and the blood loss was 500 mL. The patient recovered uneventfully and was discharged on the 16th postoperative day. In terms of recovery and quality of life, laparoscopic total gastrectomy is a technically feasible and reasonable option for the management of early gastric cancer in the proximal stomach, especially when an endoscopic mucosal resection is not indicated.