Robotic Subtotal Gastrectomy
March 24, 2012
SUMMARY: The procedure starts with minimally invasive technique.
The abdominal cavity exploration doesn’t reveal ascites , carcinosis neither hepatic lesions.
The endoscopic tattoo of the gastric lesion is identified at the lesser curvature of the stomach.
The first step, the coloepiploic detachment, is performed until the gastrosplenic ligament with the section of the short gastric vessels. The pancreatic plane and the retrocavity of the epiploon are not involved by cancer.
Now the robot is installed in the operative field. The right gastroepiploic vessels are sectioned on Hem-o-lok clips and the lymphodenectomy of the station 6 and 14v (SMV) is performed, The right gastric vessels are sectioned between Hem-o-lok and the duodenum is prepared and sectioned by stapler (lymphoadenectomy of station 5). Now the lymphoadenectomy is performed on hepatic artery (12a), celiac trunk (9), left gastric artery (7) nand splenic artery (11p). The left gastric artery is sectioned and then the gastric body by an endoscopic stapler: subtotal gastrectomy with D2 lymphoadenectomy is performed.
The specimen is extracted by a minilaparotomy on the left side of the abdominal wall.
The reconstructive is done by an antecolic Roux en Y gastro-jejunostomy.