Laparoscopic Gastrectomy for Gastric Cancer Surgical Technique and Lymphadenectomy 1st edition by Chang Ming Huang, Chao Hui Zheng ISBN 9401798729 978-9401798723

Introduction of Chief Editors

1: Summary of Anatomy and Physiology of Perigastric Lymphatic System

1.1 Lymphatic Drainage Routes of the Stomach

1.2 Lymph Node Groups in Gastric Cancer

1.3 Pattern of Metastatic Spread and Characteristics of Metastatic LNs in Gastric Cancer

1.4 Types and Characteristics of Metastatic LNs in Gastric Cancer

2: The Current Status and Development of Lymph Node Dissection for Gastric Cancer

2.1 The Extent of Lymphadenectomy in Early Gastric Cancer (EGC)

2.2 The Extent of Lymphadenectomy for Advanced Gastric Cancer

2.3 The Application of Laparoscopic Techniques in Lymphadenectomy

References

3: Preoperative Notes of Laparoscopic Lymph Node Dissection for Gastric Cancer

3.1 Instruments

3.1.1 Routine Devices

3.1.2 Special Devices

3.2 Patient’s Position

3.3 Surgeons’ Locations

3.4 Location of Trocars

3.5 Establishment of Pneumoperitoneum

3.6 Preoperative Exploration

3.7 Sequence of a Lymphadenectomy

3.8 Nursing Cooperation

3.8.1 Preoperative Visit

3.8.2 Preparation of Instruments

3.8.3 Preparation of Operating Room

4: Laparoscopic Infrapyloric Area Lymph Node Dissection for Gastric Cancer

4.1 Review of Laparoscopic Infrapyloric Area Lymph Node Dissection for Gastric Cancer

4.2 Anatomy Associated with Lymph Node Dissection in the Infrapyloric Area

4.2.1 Fascia and Intrafascial Space in the Infrapyloric Area

4.2.1.1 Greater Omentum

4.2.1.2 Gastrocolic Intrafascial Space (GIS)

4.2.1.3 TM

4.2.1.4 Pancreaticoduodenal Fascia (PDF) and Its Intrafascial Space

4.2.2 Vascular Anatomy Associated with Lymph Node Dissection in the Infrapyloric Area

4.2.2.1 Arteries Associated with Lymph Node Dissection in the Infrapyloric Area

Right Gastroepiploic Artery (REGA)

Infrapyloric Artery (IPA)

Superior Pancreaticoduodenal Artery (SPDA)

4.2.2.2 Veins Associated with Lymph Node Dissection in the Infrapyloric Area

Right Gastroepiploic Vein (RGEV)

SMV

MCV

4.2.3 Lymph Node Anatomy of the Infrapyloric Area

4.2.3.1 The No. 6 LNs (Infrapyloric LNs)

Definition of the No. 6 LNs

Cases of No. 6 LNM

4.2.3.2 The No. 14v LNs (LNs Located at the Root of the SMV)

Definition of the No. 14v LNs

Cases of No. 14v LNM

4.3 Procedures for Lymph Node Dissection in the Infrapyloric Area

4.3.1 Removing the Greater Omentum and Peeling the Anterior Lobe of the Transverse Mesocolon 

4.3.1.1 Removing the Greater Omentum

Operative Approach

Exposure Methods

Operative Procedures

4.3.1.2 Peeling the ATM

Operative Approach

Exposure Methods

Operative Procedures

4.3.2 Dissection of the No. 14v LNs

4.3.2.1 Operative Approach

4.3.2.2 Exposure Methods

4.3.2.3 Operative Procedures

4.3.3 Dissection of the No. 6 LNs

4.3.3.1 Operative Approach

4.3.3.2 Exposure Methods

4.3.3.3 Operative Procedures

4.4 Common Situations Encountered and Surgical Techniques Utilized During the Dissection of the

4.4.1 Surgical Techniques Utilized in Resection of the Greater Omentum and Division of the AT

4.4.1.1 Excision of the Greater Omentum

Surgical Techniques Involved in Division

Prevention of Damage to Adjacent Tissues and Organs

Prevention of Vascular Injury

4.4.1.2 Division of the ATM

Surgical Techniques Involved in Division

Prevention of Damage to Adjacent Tissues and Organs

Prevention of Vascular Injury

4.4.2 Surgical Techniques Involved in Dissection of the No. 14v LNs

4.4.2.1 Surgical Techniques Involved in Dissection

4.4.2.2 Prevention of Damage to Adjacent Tissues and Organs

4.4.2.3 Prevention of Vascular Injury

4.4.3 Surgical Techniques Involved in Dissection of the No. 6 LNs

4.4.3.1 Surgical Techniques Involved in Dissection

4.4.3.2 Prevention of Damage to Adjacent Tissues and Organs

4.4.3.3 Prevention of Vascular Injury

References

5: Laparoscopic Suprapancreatic Area Lymph Node Dissection for Gastric Cancer

5.1 Review of Laparoscopic Suprapancreatic Area Lymph Node Dissection for Gastric Cancer

5.2 Anatomy Associated with Lymph Node Dissection in the Suprapancreatic Area

5.2.1 Fascia and Intrafascial Space in the Suprapancreatic Area

5.2.1.1 Pancreatic Fascia and the Intrafascial Space

5.2.1.2 Gastropancreatic and Hepatopancreatic Folds

5.2.1.3 HDL

5.2.1.4 Retrogastric Space (RGS)

5.2.2 Vascular Anatomy Associated with Lymph Node Dissection in the Suprapancreatic Area

5.2.2.1 Arteries Associated with Lymph Node Dissection in the Suprapancreatic Area

CA

LGA

CHA

GDA

PHA

RGA

SpA

5.2.2.2 Veins Associated with Lymph Node Dissection in the Suprapancreatic Area

Left Gastric Vein (LGV)

SpV

PV

RGV

5.2.3 Lymph Node Anatomy of the Suprapancreatic Area

5.2.3.1 The No. 9 LNs (LNs Around the CA)

Definition of the No. 9 LNs

No. 9 LNM (Figs. 5.88, 5.89, and 5.90)

5.2.3.2 The No. 7 LNs (LNs Around the LGA)

Definition of the No. 7 LNs

No. 7 LNM (Figs. 5.93, 5.94, and 5.95)

5.2.3.3 The No. 8 LNs (LNs Around the CHA)

Definition of the No. 8 LNs

No. 8 LNM (Figs. 5.98, 5.99, 5.100, 5.101, and 5.102)

5.2.3.4 No. 12 LNs (LNs in the HDL)

Definition of the No. 12 LNs

No. 12 LNM (Figs. 5.105, 5.106, and 5.107)

5.2.3.5 The No. 5 LNs (Suprapyloric LNs)

Definition of the No. 5 LNs

No. 5 LNM (Figs. 5.110, 5.111, and 5.112)

5.2.3.6 View of LNs in the Suprapancreatic Area Before and After Neoadjuvant Chemotherapy

5.3 Procedures for Lymph Node Dissection in the Suprapancreatic Area

5.3.1 Dissection of the No. 7, 8a, 9, and 11p LNs

5.3.1.1 Operative Approach

5.3.1.2 Exposure Methods

5.3.1.3 Operative Procedures

5.3.2 Dissection of the No. 5 and No. 12a LNs

5.3.2.1 Operative Approach

5.3.2.2 Exposure Methods

5.3.2.3 Operative Approach

5.4 Common Situations Encountered and Surgical Techniques utilized During the Dissection of the

5.4.1 Surgical Techniques Involved in Dissection of No. 7, 8a, 9, and 11p LNs

5.4.1.1 Surgical Techniques Involved in Dissection

5.4.1.2 Prevention of Damage to Adjacent Tissues and Organs

5.4.1.3 Prevention of Vascular Injury

5.4.2 Surgical Techniques Involved in Dissection of the No. 12a and 5 LNs

5.4.2.1 Surgical Techniques Involved in Dissection

5.4.2.2 Prevention of Damage to Adjacent Tissues and Organs

Vascular Injury Prevention

References

6: Laparoscopic Splenic Hilar Area Lymph Node Dissection for Gastric Cancer

6.1 Review of Laparoscopic Splenic Hilar Area Lymph Node Dissection for Gastric Cancer

6.2 Anatomy Associated with Lymph Node Dissection in the Splenic Hilar Area

6.2.1 Fascia and Intrafascial Space in the Splenic Hilar Area

6.2.1.1 Gastrosplenic and Splenorenal Ligaments

6.2.1.2 Toldt’s Space (TS) and Gerota’s Fascia

6.2.2 Vascular Anatomy Associated with Lymph Node Dissection in the Splenic Hilar Area

6.2.2.1 Arterial Anatomy Associated with Lymph Node Dissection in the Splenic Hilar Area

SpA

Relation Between the Course of the SpA and the Pancreas

Branches of the SpA

Splenic Lobar Artery (SLA)

Splenic Pole Artery (SPoA)

LGEA

Short Gastric Artery (SGA)

Posterior Gastric Artery (PGA)

Classification of the Terminal Branches of the SpA

6.2.2.2 Veins Associated with Lymph Node Dissection in the Splenic Hilar Area

Left Gastroepiploic Vein (LGEV)

SpV

6.2.3 Lymph Node Anatomy Associated with Lymph Node Dissection in the Splenic Hilar Area

6.2.3.1 No. 4 LNs (LNs Around the Greater Curvature of the Stomach)

No. 4d LNs

Definition of the No. 4d LNs

No. 4d LNM (Figs. 6.57 and 6.58)

No. 4sb LNs

Definition of the No. 4sb LNs

No. 4sb LNM (Figs. 6.60, 6.61, and 6.62)

No. 4sa LNs

Definition of the No. 4sa LNs

No. 4sa LNM (Fig. 6.64)

6.2.3.2 No. 10 LNs (LNs Located at the Splenic Hilar)

Definition of the No. 10 LNs

No. 10 LNM (Figs. 6.67, 6.68, and 6.69)

6.2.3.3 No. 11 LNs (LNs Along the Trunk of SpA)

Definition of the No. 11 LNs

No. 11 LNM (Figs. 6.72 and 6.73)

6.3 Procedures for Lymph Node Dissection in the Splenic Hilar Area

6.3.1 Operative Approach

6.3.2 Exposure Methods

6.3.3 Operative Procedures

6.3.3.1 First Step: Dissection of the LNs in the Inferior Pole Region of the Spleen

6.3.3.2 Second Step: Dissection of the LNs in the Region of the Trunk of SpAT

6.3.3.3 Third Step: Dissection of the LNs in the Superior Pole Region of the Spleen

6.4 Common Situations Encountered and Surgical Techniques Utilized During the Dissection of the

6.4.1 Surgical Techniques Involved in Division

6.4.2 Prevention of Damage to Adjacent Tissues and Organs

6.4.3 Prevention of Vascular Injury

References

7: Laparoscopic Cardial Area Lymph Node Dissection for Gastric Cancer

7.1 Review of Laparoscopic Cardial Area Lymph Node Dissection for Gastric Cancer

7.2 Anatomy Associated with Lymph Node Dissection in the Cardial Area

7.2.1 Fascia and Intrafascial Space in the Cardial Area

7.2.1.1 Gastrophrenic Ligament (GPL)

7.2.1.2 Hepatogastric Ligament

7.2.2 Vascular Anatomy Associated with Lymph Node Dissection in the Cardial Area

7.2.2.1 Arteries Associated with Lymph Node Dissection in the Cardial Area

Terminal Branch of the LGA

Fundic Branch of the LIPA

7.2.2.2 Veins Associated with Lymph Node Dissection in the Cardial Area

7.2.3 Lymph Node Anatomy of the Cardial Area

7.2.3.1 The No. 1 LNs (Right Paracardial LNs)

Definition of the No. 1 LNs

Case of No. 1 LNM (Figs. 7.18 and 7.19)

7.2.3.2 The No. 2 LNs (Left Paracardial LNs)

Definition of the No. 2 LNs

Case of No. 2 LNM (Figs. 7.22, 7.23, and 7.24)

7.2.3.3 The No. 3 LNs (LNs along the Gastric Lesser Curvature)

Definition of the No. 3 LNs

Case of No. 3 LNM (Figs. 7.27 and 7.28)

7.3 Procedures for Lymph Node Dissection in the Cardial Area

7.3.1 Baring of the Gastric Lesser Curvature and Dissection of the No. 1 and No. 3 LNs

7.3.1.1 Operative Approach

7.3.1.2 Exposure Methods

7.3.1.3 Operative Procedures

7.3.2 Baring of the Left Side of the Esophagus and Dissection of the  No. 2 LNs

7.4 Common Situations Encountered and Surgical Techniques Utilized During the Dissection of the 

7.4.1 Surgical Techniques Involved in Division

7.4.2 Prevention of Damage to Adjacent Tissues and Organs

7.4.3 Prevention of Vascular Injury

References

8: Reconstruction of the Digestive Tract After Laparoscopic Gastrectomy for Gastric Cancer

8.1 Outline of Reconstruction After Laparoscopic Radical Gastrectomy

8.1.1 Reconstruction Approach After Laparoscopic Gastrectomy

8.1.2 Technical Tips of Reconstruction After Laparoscopic Radical Gastrectomy

8.1.2.1 Pay Attention to Operational Details and Avoid Unnecessary Injury

8.1.2.2 Ensure Quality of the Anastomosis and Reduce the Postoperative Complications

8.1.2.3 Familiarity with Instruments’ Use to Reduce Trauma

8.2 Reconstruction of the Digestive Tract After LAG

8.2.1 Technical Tips of Billroth-I Anastomosis in LADG

8.2.2 Technical Tips of Roux-en-Y Anastomosis in LATG

8.3 Reconstruction of the Digestive Tract After TLG for Gastric Cancer

8.3.1 Characteristics of Reconstruction After TLG

8.3.1.1 Superiorities of TLG for Gastric Cancer

8.3.1.2 Influence of the Staplers for Anastomosis on Laparoscopic Reconstruction of the Diges

8.3.2 Indications for Totally Laparoscopic Reconstruction of the Digestive Tract

8.3.2.1 Reconstruction of the Digestive Tract After Distal Gastrectomy

8.3.2.2 Reconstruction of Digestive Tract After Total Gastrectomy

8.3.3 Procedures of Reconstruction After TLG

8.3.4 Delta-Shaped Billroth-I Anastomosis After TLDG

8.3.4.1 Anastomosis Method

8.3.4.2 Technical Tips

8.3.5 Billroth-II Anastomosis After TLDG

8.3.5.1 Anastomosis Method

8.3.5.2 Technical Tips

8.3.6 Functional Side-to-Side Esophagojejunostomy After TLTG

8.3.6.1 Anastomosis Method

8.3.6.2 Technical Tips

8.3.7 Orvil™: Assisted Anastomosis After TLTG

8.3.7.1 Anastomosis Method

8.3.7.2 Technical Tips

References

9: Prevention and Treatment of Complications Associated with Laparoscopic Surgery for Gastric Ca

9.1 Abdominal Complications Associated with Surgery

9.1.1 Intra-abdominal Bleeding

9.1.2 Duodenal Fistula (DF)

9.1.3 Anastomotic Complications

9.1.4 Pancreatic Fistula (PF) and Pancreatitis

9.1.5 Lymphatic Fistula (LF)

9.1.6 Ileus

9.1.7 Delayed Gastric Emptying

9.2 Systemic Complications

9.3 Complications Associated with Pneumoperitoneum

9.4 Complications Associated with the Insertion of a Trocar and the Accessory Incision

References