Abstract

Background: The securement of a field of view by pancreatic rotating technique for suprapancreatic lymphnode dissection in laparoscopic gastrectomy (LG) has a huge effect on the accuracy of dissection and is associated with the frequency of pancreatic fistula. Here, we report a delicate, safe and easy rotation technique of pancreas with “Naruke Type Thoraco Cotton” (TC; KENZMEDICO).
Methods: We evaluated the data of 34 patients who underwent laparoscopic distal gastrectomy (LDG) with suprapancreatic lymphadenectomy for gastric cancer. TC was used to compress the pancreas to secure the field of view for lymphadenectomy. During we underwent the suprapancreatic lymphnode dissection, the assistant inserted the TC from 12mm trocar with the left hand, and applied pressure to the lower surface of pancreas. We showed the clinicopathologic characteristics, operative outcomes, intraoperative complications, serum amylase concentration (s-AMY) on postoperative day 3 (POD3), and amylase concentration of drainage fluid (d-AMY) on POD3, and rates of postoperative pancreasrelated complications.
Results: The procedures of lymphadenectomy were undertaken smoothly and clearly with TC. The number of the cases of postoperative pancreas-related complication was only one with D2 lymphnode dissection (Grade2 pancreatic fistula; 2.9%). The median values of d-AMY on POD3 were only 179 IU/l.
Conclusions: TC should be considered as a useful option in the safe and precise pancreatic rotation technique for suprapancreatic lymphnode dissection.