Laparoscopic Gastric Surgery

Indications

GIST, EGC, Benign pathology, palliative settings

For EGC: preoperative endoscopy and India ink tattoo: consider whether adequate Rx: some authors suggest subtotal and D1 dissection is minimum reqd as local recurrence rate is high

Laparoscopic partial gastrectomy
Small lesions at fundus of anterior wall: Endoscopic linear cutter stapler
If involves greater or lesser curve, divide vascular arcades with harmonic scalpel then several linear cutter staplers. Intra-operative gastroscopy to ensure lesion clearance.

Laparoscopic distal/subtotal gastrectomy
Billroth II recontruction with endoscopic linear staplers, close defect with intracorporeal suture. Be generous with margins in EGC.

Laparoscopic total
Oesophagojejunostomy with endoscopic linear and circular staplers reinforced by seromuscular sutures


If significant adhesion from previous surgery, divide gastrocolic omentum to enter lesser sac and virgin posterior wall of stomach. Then identify posterior and left gastric vessels before proceeding.