How I do it: technical tips of laparoscopic surgery for advanced gastric cancer

Laparoscopic distal gastrectomy with radical lymphadenectomy for early gastric cancer is technically established, and it has penetrated clinical scene worldwide. Meanwhile, in terms of expanding its indication to more advanced gastric cancer, there are still a lot of arguments in both technical and oncological viewpoints, and we should wait for the upcoming long-term results of large-scaled randomized studies. Technically, without doubt accurate complete D2 dissection is necessary for advanced gastric cancer, and additionally in whatever situation surgeons should follow oncological principles, not to cause cancer cell spillage or local residue due to inadequate dissection during the surgery. To keep dry operative fields, water absorptive surgical sponges are effective. Special gauze for endoscopic surgery or pre-tied loop can be utilized to create efficient traction without touching the tumor surface. Several kinds of recovery measures for intraoperative hemorrhage should be noted in surgical team, in case.