Advanced technique of reduced-port laparoscopic total gastrectomy for gastric cancer

We started reduced-port laparoscopic gastrectomy (RPG) through an umbilical multichannel port and an additional port [dual-port laparoscopic gastrectomy (DP-LG)] for gastric cancer in December 2009, and accumulated experience of 100 cases. In the DP-LG group, 79 patients underwent DP-laparoscopic distal gastrectomy and 21 underwent DP-laparoscopic total gastrectomy (DP-LTG). In this report, we explained our methods and devices of DP-LTG, which is the most difficult procedure in the field of PRGs. Patients were placed in Fowler’s position with legs abducted. A SILS™ port (Covidien Japan Inc, Tokyo, Japan) was inserted into an umbilical incision, while another 5-mm port was inserted in the right flank region. A 5-mm flexible scope was inserted through the 5-mm trocar at the extreme caudal position of the SILS™ port. The surgeon used two trocars in the SILS™ port to manipulate the greater curvature side of the stomach, or one trocar in the SILS™ port and another in the right flank port to manipulate the other side. The surgeon stood between the patient’s legs in the former situation and on the right side of the patient in the latter. The assistant used the remaining trocar to provide support.