Technical Points of Laparoscopy Assisted ftjstal Gastrectomy with D2 Lymph Nodes Dissection

摘要

We demonstrated technical points of laparoscopy assisted distal gastrectomy (LADG) with D2 dissection. During operation, sentinel nodes identified by RI method were examined for metastasis in frozen section. 1) Dissection of No.l4v: we opened the peritoneum at the lower edge of pancreas in order to expose SMV. The point of this process was to confirm middle colic vein, gastro-colic trunk and determine the area of No.l4v. 2) Dissection of No.l2a: A junction of gastro-duodenal artery and common hepatic artery was exposed. And No. 12a was dissected along with proper hepatic artery. 3) Dissection of No.lip: Peritoneum was opened along with the upper edge of pancreas. Posterior gastric artery was observed at the border of distal side at No.l Id. D2 dissection was possible even in LADG as same as open surgery.