Abstract:

After the separating the greater omentum and the left gastroepiploic vessel, the right gastroepiploic vein and artery were ligated in order to dissect lymph nodes (LNs) No.4sb and No.6. Dissection of suprapancreatic area LNs was started from the root of splenic artery. LNs No.11p, 9, 7, 8a, 12a and 5 were dissected in sequence. Duodenum was transected followed by dissection of LNs No.12a, 11d and 10. A sterile hemp rope was held to ligate and drag down the esophagus to maintain'self-pulling' environment , allowing the detachment of the posterior mediastinum. Then a hole was made on the right-posterior wall of the esophagus above the ligature rope. After mobilizing the mesentery, the small intestine was made at the anti-mesenteric border of the jejunum 25 cm distal to the ligament of Treitz. A side-to-side esophagojejunostomy (E-J) was then performed between the right-posterior wall of esophagus and the anti-mesenteric wall of the jejunum to form an entry hole. The 'latter transection' applied with the stapler inserted from the trocar of assistant's main operating holeand therefore enabled the esophagus and the proximal jejunum to be simultaneously transected above the level of the entry hole. After that, a side-to-side jejunojejunostomy (J-J)was carried out between the afferent loop stump and the roux limb 45 cm below E-J.

Key words: Stomach neoplasms, Laparoscopes, Gastrectomy