Abstract:

Using laparoscopy to investigate the primary lesion and determine whether there was a metastasis in the abdominal pelvis. The gastrocolic ligament was separated through the approach near the central margin of the transverse colon. Separated the gastrocolic ligament to the splenic flexure of colon in the left and hepatic flexure of colon in the right. Indocyanine green (ICG)-guided laparoscopic lymphadenectomy was then performed. Naked and cut off the right gastroepiploic vein and the right gastroepiploic artery in order to complete the lymph node (LN) dissection in the infrapyloric region. Opened the gastropancreatic fold and went into the posterior space of the pancreas from the left side of the suprapancreatic area. Then separated and exposed the initial segment of the splenic artery, and cleaned the No.11p LNs. Naked and cut off the left gastric artery, and cleaned the No.7 and No.9 LNs. Removed the fatty tissues and LNs above the anterior common hepatic artery totally to complete the No.8a LN dissection. Dissected the No.5 and No.12a LNs to the left to complete the suprapancreatic LN dissection. According to the Huang's three-step maneuver, removed the LNs of the inferior pole region of spleen, region of splenic trunk and superior pole region of the spleen, respectively. ICG fluorescence examined whether there was residual LN. Finally, Roux-en-Y esophagojejunostomy was performed under laparoscopy.

Key words: Neoplasm of Stomach, Total Gastrectomy, Laparoscopy, Indocyanine green