J Gastric Cancer.  2017 Sep;17(3):193-203. 10.5230/jgc.2017.17.e29.

Single-incision Laparoscopic Gastrectomy for Gastric Cancer

• Lee Y
• Kim HH

• KMID: 2389823
• DOI: http://doi.org/10.5230/jgc.2017.17.e29

Abstract

The implementation of national cancer screening has increased the detection rates of early gastric cancer (EGC) in Korea. Since the successful introduction of laparoscopic gastrectomy for gastric cancer in the early 1990s, this technique has demonstrated improved short-term outcomes without compromising long-term oncologic results. It is associated with reduced pain, shorter hospitalization, reduced morbidity rates, better cosmetic outcomes, and equivalent mortality rates as those for open surgery. Laparoscopic gastrectomy improves patients' quality of life (QOL) and provides favorable prognosis. Single-incision laparoscopic gastrectomy (SILG) is one extremely minimally invasive method, theoretically offering improved cosmetic results, less postoperative pain, and earlier recovery after surgery than conventional multiport laparoscopic gastrectomy. In this context, SILG is thought to be an optimal method to promote and maximize patients' QOL in the acute postoperative phase. However, the technical difficulties of this procedure have limited its use. Since the first report describing single-incision distal gastrectomy in 2011, only 16 studies to date have evaluated SILG. Most of these studies have focused on the technical feasibility and safety of SILG because its long-term outcomes have not been reported. This article reviews the advantages and limitations of SILG.

Keyword

Stomach neoplasms; Laparoscopy; Gastrectomy

MeSH Terms

Early Detection of Cancer
Gastrectomy*
Hospitalization
Korea
Laparoscopy
Methods
Mortality
Pain, Postoperative
Prognosis
Quality of Life
Stomach Neoplasms*

Figure

• 

  Fig. 1 The position in SILG. The patient was placed in a supine position with the legs apart and in the reverse Trendelenburg position. The pouches for laparoscopic instruments were attached on both sides of the patients. The monitors were placed on the cranial side of the patient. SILG = single-incision laparoscopic gastrectomy.

• 

  Fig. 2 Placing gauze between the pancreas and antrum of the stomach to construct surgical space and to absorb fluid and blood excreted during the procedure.

Reference

1. Yang HK, Suh YS, Lee HJ. Minimally invasive approaches for gastric cancer-Korean experience. J Surg Oncol. 2013; 107:277–281.

2. Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report--a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg. 2010; 251:417–420.

3. Hwang SH, Park DJ, Jee YS, Kim MC, Kim HH, Lee HJ, et al. Actual 3-year survival after laparoscopy-assisted gastrectomy for gastric cancer. Arch Surg. 2009; 144:559–564.

4. Pfluke JM, Parker M, Stauffer JA, Paetau AA, Bowers SP, Asbun HJ, et al. Laparoscopic surgery performed through a single incision: a systematic review of the current literature. J Am Coll Surg. 2011; 212:113–118.

5. Omori T, Oyama T, Akamatsu H, Tori M, Ueshima S, Nishida T. Transumbilical single-incision laparoscopic distal gastrectomy for early gastric cancer. Surg Endosc. 2011; 25:2400–2404.

6. Gagner M, Garcia-Ruiz A. Technical aspects of minimally invasive abdominal surgery performed with needlescopic instruments. Surg Laparosc Endosc. 1998; 8:171–179.

7. Tagaya N, Kubota K. Reevaluation of needlescopic surgery. Surg Endosc. 2012; 26:137–143.

8. Park DJ, Lee JH, Ahn SH, Eng AK, Kim HH. Single-port laparoscopic distal gastrectomy with D1+β lymph node dissection for gastric cancers: report of 2 cases. Surg Laparosc Endosc Percutan Tech. 2012; 22:e214–e216.

9. Ahn SH, Park DJ, Kim HH. Single-incision laparoscopic distal gastrectomy for early gastric cancer. Transl Gastrointest Cancer. 2013; 2:83–86.

10. Ahn SH, Son SY, Lee CM, Jung DH, Park J, Kim HH. Intracorporeal uncut Roux-en-Y gastrojejunostomy reconstruction in pure single-incision laparoscopic distal gastrectomy for early gastric cancer: unaided stapling closure. J Am Coll Surg. 2014; 218:e17–e21.

11. Suh YS, Park JH, Kim TH, Huh YJ, Son YG, Yang JY, et al. Unaided stapling technique for pure single-incision distal gastrectomy in early gastric cancer: unaided delta-shaped anastomosis and uncut Roux-en-Y anastomosis. J Gastric Cancer. 2015; 15:105–112.

12. Ahn SH, Park DJ, Son SY, Lee CM, Kim HH. Single-incision laparoscopic total gastrectomy with D1+beta lymph node dissection for proximal early gastric cancer. Gastric Cancer. 2014; 17:392–396.

13. Lee CM, Park DW, Jung DH, Jang YJ, Kim JH, Park S, et al. Single-port laparoscopic proximal gastrectomy with double tract reconstruction for early gastric cancer: report of a case. J Gastric Cancer. 2016; 16:200–206.

14. O’Boyle CA. Assessment of quality of life in surgery. Br J Surg. 1992; 79:395–398.

15. Podda M, Saba A, Porru F, Pisanu A. Systematic review with meta-analysis of studies comparing single-incision laparoscopic colectomy and multiport laparoscopic colectomy. Surg Endosc. 2016; 30:4697–4720.

16. Lurje G, Raptis DA, Steinemann DC, Amygdalos I, Kambakamba P, Petrowsky H, et al. Cosmesis and body image in patients undergoing single-port versus conventional laparoscopic cholecystectomy: a multicenter double-blinded randomized controlled trial (SPOCC-trial). Ann Surg. 2015; 262:728–734.

17. Kim SM, Ha MH, Seo JE, Kim JE, Choi MG, Sohn TS, et al. Comparison of single-port and reduced-port totally laparoscopic distal gastrectomy for patients with early gastric cancer. Surg Endosc. 2016; 30:3950–3957.

18. Ahn SH, Son SY, Jung DH, Park DJ, Kim HH. Pure single-port laparoscopic distal gastrectomy for early gastric cancer: comparative study with multi-port laparoscopic distal gastrectomy. J Am Coll Surg. 2014; 219:933–943.

19. Noguera J, Tejada S, Tortajada C, Sánchez A, Muñoz J. Prospective, randomized clinical trial comparing the use of a single-port device with that of a flexible endoscope with no other device for transumbilical cholecystectomy: LLATZER-FSIS pilot study. Surg Endosc. 2013; 27:4284–4290.

20. Ahn SH, Jung DH, Son SY, Park DJ, Kim HH. Pure single-incision laparoscopic D2 lymphadenectomy for gastric cancer: a novel approach to 11p lymph node dissection (midpancreas mobilization). Ann Surg Treat Res. 2014; 87:279–283.

21. Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y. A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery. 2002; 131:S306–S311.

22. Velthuis S, van den Boezem PB, Lips DJ, Prins HA, Cuesta MA, Sietses C. Comparison of short-term surgical outcomes after single-incision laparoscopic versus multiport laparoscopic right colectomy: a two-center, prospective case-controlled study of 100 patients. Dig Surg. 2012; 29:477–483.

23. Kim SJ, Ryu GO, Choi BJ, Kim JG, Lee KJ, Lee SC, et al. The short-term outcomes of conventional and single-port laparoscopic surgery for colorectal cancer. Ann Surg. 2011; 254:933–940.

24. Kunisaki C, Makino H, Yamamoto N, Sato T, Oshima T, Nagano Y, et al. Learning curve for laparoscopy-assisted distal gastrectomy with regional lymph node dissection for early gastric cancer. Surg Laparosc Endosc Percutan Tech. 2008; 18:236–241.

25. Lee JH, Lee MS, Kim HH, Park DJ, Lee HJ, Yang HK, et al. Comparison of single-incision laparoscopic distal gastrectomy and laparoscopic distal gastrectomy for gastric cancer in a porcine model. J Laparoendosc Adv Surg Tech A. 2011; 21:935–940.

26. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011; 14:101–112.

27. Omori T, Fujiwara Y, Moon J, Sugimura K, Miyata H, Masuzawa T, et al. Comparison of single-incision and conventional multi-port laparoscopic distal gastrectomy with D2 lymph node dissection for gastric cancer: a propensity score-matched analysis. Ann Surg Oncol. 2016; 23:817–824.

28. Shabbir A, Lee JH, Lee MS, Park DJ, Kim HH. Combined suture retraction of the falciform ligament and the left lobe of the liver during laparoscopic total gastrectomy. Surg Endosc. 2010; 24:3237–3240.

29. Shinohara H, Kurahashi Y, Kanaya S, Haruta S, Ueno M, Udagawa H, et al. Topographic anatomy and laparoscopic technique for dissection of no. 6 infrapyloric lymph nodes in gastric cancer surgery. Gastric Cancer. 2013; 16:615–620.

30. Kong J, Wu SD, Su Y. Translumenal single-incision laparoscopy radical gastrectomy with D2 lymph node dissection for early gastric cancer--primary experience with less invasive surgery in China. J Laparoendosc Adv Surg Tech A. 2013; 23:141–145.

31. Omori T, Tanaka K, Tori M, Ueshima S, Akamatsu H, Nishida T. Intracorporeal circular-stapled Billroth I anastomosis in single-incision laparoscopic distal gastrectomy. Surg Endosc. 2012; 26:1490–1494.

32. Omori T, Masuzawa T, Akamatsu H, Nishida T. A simple and safe method for Billroth I reconstruction in single-incision laparoscopic gastrectomy using a novel intracorporeal triangular anastomotic technique. J Gastrointest Surg. 2014; 18:613–616.

33. Kim SM, Lee SH, Ha MH, Seo JE, Kim JE, Choi MG, et al. Techniques of the single-port totally laparoscopic distal gastrectomy. Ann Surg Oncol. 2015; 22:Suppl 3. S341.

34. Ertem M, Ozveri E, Gok H, Ozben V. Single incision laparoscopic total gastrectomy and d2 lymph node dissection for gastric cancer using a four-access single port: the first experience. Case Rep Surg. 2013; 2013:504549.

35. Ahn SH, Son SY, Jung DH, Park YS, Shin DJ, Park DJ, et al. Solo intracorporeal esophagojejunostomy reconstruction using a laparoscopic scope holder in single-port laparoscopic total gastrectomy for early gastric cancer. J Gastric Cancer. 2015; 15:132–138.