Laparoscopy-assisted gastrectomy with extraperigastric lymph node dissection for gastric cancer is a complicated procedure
that generally requires advanced laparoscopic surgical skill. We devised a simplified but effective laparoscopic procedure
that provides a better visual field to perform safe lymph node dissection more quickly. First, a mini-laparotomy is done and
a clear visual field is created by pulling a mini-retractor to the right or left. The laparoscopic procedure is made easier
and safer by taping the stomach body, and by using the fringe of an abdominal wall sealing device (Lapdisk) placed behind
the stomach, and a scope holder for the snake-retractor. The lymph nodes along the common hepatic vessels, left gastric vessels,
and celiac artery (extraperigastric lymph nodes) are then dissected laparoscopically. The suprapyloric and infrapyloric lymph
nodes are dissected through the mini-laparotomy incision and gastroduodenostomy is done using an anastomotic device. We performed
laparoscopy-assisted distal gastrectomy (LADG) in 70 patients with gastric carcinomas located in the distal stomach (mean
body mass index: 24.3). The mean operating time was 170 min and blood loss was minimal. All patients recovered well with minimal
pain and good postoperative quality of life. We conclude that our simple and practical procedure for LADG with extraperigastric
lymph node dissection can be performed safely and easily.
Key words Laparoscopy-assisted gastrectomy - Gastric cancer - Extraperigastric lymph nodes - Lymph node dissection - Mini-laparotomy - Mini-retractor