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Qian Y, Zhou G, Chang F, Ping X, Wang G. Simplified Roux-en-Y reconstruction after laparoscopic radical distal gastrectomy for gastric cancer. Front Surg 2022; 9:994659. [PMID: 36268210 PMCID: PMC9577218 DOI: 10.3389/fsurg.2022.994659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/12/2022] [Indexed: 11/07/2022] Open
Abstract
Background Although there were a variety of strategies for the alimentary tract reconstruction of patients with gastric cancer who underwent laparoscopic radical distal gastrectomy, it remains controversial regarding which procedure is optimal. We developed a simple technique for Roux-en-Y reconstruction during laparoscopic surgery and evaluated its technical feasibility and safety. Methods Seventy-one cases of modified Roux-en-Y reconstructions after laparoscopic radical distal gastrectomy were consecutively performed in our hospital, from November 2020 to March 2022. A retrospective review of medical data was conducted. Intraoperative and postoperative outcomes, including operation time and incidence of postoperative complications, were collected and analyzed. Results All procedures of laparoscopic distal gastrectomy with D2 lymph node dissection were successfully completed without any intraoperative complication. The mean number of retrieved lymph node was 38.8 ± 10.6. Mean operative time was 223.5 ± 42.4 min, whereas intraoperative blood loss was 102.2 ± 96.3 ml. No postoperative mortality was recorded. Six patients (8.5%) experienced postoperative complications and were managed conservatively. In addition, only two patients (2.8%) required rehospitalization during a median short-term follow-up period of 6 months. Conclusions The modified method is a simple and safe approach for laparoscopic radical distal gastrectomy.
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Affiliation(s)
- Yawei Qian
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,Division of Gastric Surgery, Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guang Zhou
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,Department of General Surgery, Nanjing Central Hospital, Nanjing, China
| | - Feifei Chang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaochun Ping
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,Division of Gastric Surgery, Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,Correspondence: Xiaochun Ping
| | - Guoliang Wang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,Division of Gastric Surgery, Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Comparison Between Uncut Roux-en-Y Reconstruction and Billroth II Anastomosis After Laparoscopic Distal Gastrectomy for Gastric Cancer: a Meta-analysis. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03301-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Wu Z, Wang B, Liu G, Lu J, Chen F, Shi L. A modified method for Billroth-II gastrojejunostomy after laparoscopy-assisted distal gastrectomy. Transl Cancer Res 2022; 11:754-760. [PMID: 35571653 PMCID: PMC9091015 DOI: 10.21037/tcr-21-2220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/28/2022] [Indexed: 11/18/2022]
Abstract
Background There are many types of gastrojejunostomy reconstruction after laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer, each of which has merits and demerits. This study introduced a novel method (called pant-shaped anastomosis) involving the construction of a side-to-side anastomosis between the afferent loop and efferent loop at the site of gastrojejunal anastomosis using a linear stapler. The results of applying pant-shaped anastomosis to LADG were also analyzed. Methods The clinical data of 96 patients who underwent LADG with pant-shaped anastomosis between June 2018 and June 2020 at The First Affiliated Hospital of Wannan Medical College (Wuhu City, China) were analyzed retrospectively. Results All procedures were successfully completed without conversion to open laparotomy. An average pant-shaped anastomosis took 22 min to construct and had a mean incision length of 5.3 cm. The mean time to postoperative first flatus was 3.5 days. The mean time to intake of an oral semiliquid diet was 5.5 days. The average postoperative hospital stay was 8.2 days. No patient developed extraluminal bleeding, intraluminal bleeding, anastomosis leakage, afferent obstruction, internal herniation or pancreatitis. The proportion of patients who experienced significant reflux was 10.1% (Visick III-IV). In total, 62.6% of patients exhibited endoscopic reflux gastritis of grade 1 or less. Conclusions Pant-shaped anastomosis is a safe and simple procedure. It is a feasible option to reduce afferent obstruction after LADG in patients with distal gastric cancer.
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Affiliation(s)
- Zehui Wu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Bing Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Gang Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Jiaju Lu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Fangzheng Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Lianghui Shi
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
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Yüksel C, Çulcu S. New learning area in laparoscopic gastrectomy for gastric cancer: YouTube® or WebSurg®? J Minim Access Surg 2022; 18:129-135. [PMID: 35017403 PMCID: PMC8830580 DOI: 10.4103/jmas.jmas_300_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/21/2021] [Accepted: 03/24/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Laparoscopic gastrectomy cannot be performed routinely in many centres, because there is still no standardisation in the centres where it is performed, and therefore, new learning areas are needed for residents working in these centres for surgical training. These areas are various courses, video training sets and video platforms watched over the internet. The most frequently used platforms are YouTube® and WebSurg®. Our aim is to compare these two online video platforms in terms of laparoscopic gastrectomy and to evaluate the contribution of video platforms to surgical training and whether they have sufficient technical quality. MATERIALS AND METHODS We made a search on YouTube® and WebSurg® using the keyword 'laparoscopic gastrectomy' on 13 November 2020. A total of 143 videos were analysed, 111 of them on YouTube® and 32 on WebSurg®. All these videos were examined by two surgical oncologists experienced in laparoscopic gastrectomy and using laparoscopy in their daily practice. RESULTS The average video duration was 53.54 min in the YouTube® group and 18.20 min in the WebSurg® group, and this difference was found to be statistically significant between the two groups. According to the LGSS based on surgical procedures, the average score of WebSurg® videos was 10.37 and of YouTube® videos was 5.55, and there was a statistically significant difference between the two groups. CONCLUSIONS Today, video platforms have started to play a major role in surgical training. Of these platforms examined, WebSurg® is superior to YouTube® in terms of education and quality, but these platforms still have some deficiencies and need regulation.
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Affiliation(s)
- Cemil Yüksel
- Department of Surgical Oncology, SBU Ankara A.Y. Oncology Training and Research Hospital, Ankara, Turkey
| | - Serdar Çulcu
- Department of Surgical Oncology, SBU Ankara A.Y. Oncology Training and Research Hospital, Ankara, Turkey
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Zhang S, Fukunaga T, Oka S, Orita H, Kaji S, Yube Y, Yamauchi S, Kohira Y, Egawa H. Concerns of quality, utility, and reliability of laparoscopic gastrectomy for gastric cancer in public video sharing platform. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:196. [PMID: 32309343 PMCID: PMC7154475 DOI: 10.21037/atm.2020.01.78] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background The rapid expansion of laparoscopic gastrectomy (LG) for gastric cancer has generated interest among surgeons. The adequate dissemination of correct information about such advanced laparoscopic surgery can certainly be useful for surgeons and trainees. Online video resources such as YouTube are frequently used for education. This study aimed to evaluate the quality, utility, and completeness of LG videos for gastric cancer on the video website YouTube. Methods The terms “laparoscopic gastrectomy” and “gastric cancer” were searched on YouTube on August 16, 2019. The first 100 videos in three sorting categories (website’s default setting, view count, and length of duration) were checked by two experienced surgeons. The popularity was evaluated with the video power index (VPI). The reliability was measured using the Journal of American Medical Association (JAMA) benchmark criteria. The educational value and completeness were evaluated with a checklist developed by the researchers. Results A total of 102 videos were analyzed. Laparoscopic distal gastrectomy (LDG) and laparoscopic total gastrectomy were the most frequently recorded techniques. Lymph node (LN) dissection was the most frequently covered topic (89.2%), followed in descending order by GI reconstruction (87.3%). The mean VPI, JAMA benchmark score and completeness score of all videos were 2.63, 1.94 and 8.53, respectively. The types of sources were as follows: private users, 73 (71.6%); academic institutions, 20 (19.6%); and others, 9 (8%). A total of 97 videos with an identifiable primary surgeon originated from eighteen different countries. Conclusions Laparoscopic videos represented by YouTube represent a useful and appropriate educational tool. However, the quality of videos varied, and the level of information incompleteness was fairly high due to insufficient reviews. The role of private uploaders and academic institutions in surgical education cannot be overestimated. It is necessary that surgeon trainers and surgical educators critically analyze the quality of video content and exercise responsibility in directing trainee surgeons. In the current era, it is best for trainees to search for peer-reviewed content.
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Affiliation(s)
- Shun Zhang
- Department of Gastrointestinal Surgery, Shanghai East Hospital (East Hospital Affiliated to Tongji University), Shanghai 200120, China.,Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Tetsu Fukunaga
- Department of Gastrointestinal Surgery, Shanghai East Hospital (East Hospital Affiliated to Tongji University), Shanghai 200120, China
| | - Shinichi Oka
- Department of Gastrointestinal Surgery, Shanghai East Hospital (East Hospital Affiliated to Tongji University), Shanghai 200120, China
| | - Hajime Orita
- Department of Gastrointestinal Surgery, Shanghai East Hospital (East Hospital Affiliated to Tongji University), Shanghai 200120, China
| | - Sanae Kaji
- Department of Gastrointestinal Surgery, Shanghai East Hospital (East Hospital Affiliated to Tongji University), Shanghai 200120, China
| | - Yukinori Yube
- Department of Gastrointestinal Surgery, Shanghai East Hospital (East Hospital Affiliated to Tongji University), Shanghai 200120, China
| | - Suguru Yamauchi
- Department of Gastrointestinal Surgery, Shanghai East Hospital (East Hospital Affiliated to Tongji University), Shanghai 200120, China
| | - Yoshinori Kohira
- Department of Gastrointestinal Surgery, Shanghai East Hospital (East Hospital Affiliated to Tongji University), Shanghai 200120, China
| | - Hiroyuki Egawa
- Department of Gastrointestinal Surgery, Shanghai East Hospital (East Hospital Affiliated to Tongji University), Shanghai 200120, China
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Shen J, Ma X, Yang J, Zhang JP. Digestive tract reconstruction options after laparoscopic gastrectomy for gastric cancer. World J Gastrointest Oncol 2020; 12:21-36. [PMID: 31966911 PMCID: PMC6960078 DOI: 10.4251/wjgo.v12.i1.21] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 10/09/2019] [Accepted: 11/04/2019] [Indexed: 02/05/2023] Open
Abstract
In addition to the popularity of laparoscopic gastrectomy (LG), many reconstructive procedures after LG have been reported. Surgical resection and lymphatic dissection determine long-term survival; however, the election of a reconstruction procedure determines the postoperative quality of life for patients with gastric cancer (GC). Presently, no consensus exists regarding the optimal reconstructive procedure. In this review, the current state of digestive tract reconstruction after LG is reviewed. According to the determining influence of the tumor site on the procedures of surgical resection and reconstruction, we divide these reconstruction procedures into three categories consistent with the resection procedures. We focus on the technical tips of every reconstruction procedure and examine the surgical outcomes (length of surgery and blood loss) and postoperative complications (anastomotic leakage and stricture) to facilitate gastrointestinal surgeons to understand the merits and demerits of every reconstruction procedure.
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Affiliation(s)
- Jian Shen
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Xiang Ma
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Jing Yang
- Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Jian-Ping Zhang
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
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