Back to Program | 2010 Program and Abstracts Overview | 2010 Posters

Introduction: Laparoscopic gastrectomy is becoming more popular procedure in Japan. In our institution, 129 cases of the gastric cancer patients were operated last year and over the 85% of the patients were performed laparoscopic gastrectomy. One outstanding problem is intracorporeal esophago-jejunal anastomosis after total gastrectomy, because it’s technical difficulty. We introduced newly devicecd oro-gastric anvil (Orvil) for the anastomosis, and experienced over 80 cases.Method:A 10-mm trocar is placed in the umbilicus, and four additional trocars are placed. Our standard lymph node dissection is modified D2 dissection. After thorough dissection around the abdominal esophagus, it is taped and retracted. After the esophagus is divided with stapler, the tube attached to the Orvil is inserted per orally as a conventional naso-gastric tube. The tube is extracted from the esophageal stump under the direct vision of the laparoscope. The tube is extracted outside from the trocar, then the anvil is loaded into the esophageal stump. The handpiece of EEA stapler is introduced from the umbilical port incision, after the EEA stapler passed into the opening of the jejunal limb. And the anastomosis is stapled in a standard fashion.Results:We have experienced 81 cases of the laparoscopic total gsterctomy with this procedure, and no major complications have occurred.Conclusion:Using Orvil for intracorporeal Roux-en-Y anastomosis after laparoscopic total gastrectomy is safe and effective. And also, inserting handpiece of EEA stapler from the umbilical port incision is technically feasible.