Technique for laparoscopic gastric surgery

As technology and surgeon experience expand, laparoscopic surgery is playin g a larger role in the treatment of gastric conditions. We present our tech nical approach to various laparoscopic gastric resections and outline our p reliminary results. Contrary to the majority of publications on laparoscopi c gastric resection, we believe gastric mobilization should be carried out by incising the avascular plane between the greater omentum and transverse colon. This gives easy access to the origin of the left gastric artery and permits an acceptable D1 oncologic resection. For small lesions, tumor loca lization and resection margins should be mapped with the aid of routine int raoperative endoscopy. Nine patients underwent formal gastric resections, s ix of which were done for malignancy. Median time to discharge and length o f follow-up were 4.5 days (range 3-10) and 25 months (range 24-35), respect ively. One patient died postoperatively, and the remaining five patients op erated for malignancy are alive and well with no evidence of recurrent dise ase or port site metastases.