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Laparoscopic distal gastrectomy (LDG) for gastric cancer has gradually gained popularity. However, laparoscopic total gastrectomy (LTG) has been reported rarely when compared with LDG. This study was designed to evaluate the surgical outcomes as well as the morbidity and mortality of LTG compared with LDG to confirm the feasibility and safety of LTG.We reviewed the data of patients at our institution undergoing LTG (n = 448) or LDG (n = 956) for gastric cancer between January 2008 and July 2016. Then the clinical characteristics and perioperative clinical outcomes of the two groups were compared.Except for tumor size and stage, there were no statistically significant differences in the clinicopathological parameters between the groups. LTG was associated with significantly longer operation time, late time to postoperative diet, and longer hospital stay compared with the LDG group. Overall complications developed in 60 patients (13.4%) and surgical complications in 48 patients (10.7%) after LTG. Postoperative complications were less frequent in the LDG group than in the LTG group (8.4% versus 13.4%, p .01), and fewer surgical complications were observed with LDG than with LTG (7.5% versus 10.7%, p = .05).The results of LTG were favorable even though are not inferior to those of LDG. LTG for gastric cancer is technically feasible and safe. However, because of the limits of this study, other high-quality studies are needed for further evaluation.

Anatomical liver resections (ALR), which both remove the tumor and the corresponding segments, meet more with the surgical oncology’s radical nature as reported by Makuuchi.1 Nevertheless, laparoscopic ALR remains a highly specialized procedure due to technical difficulty in the selection of the transection plane. This video aimed to present a novel laparoscopic ALR strategy of tumor-bearing portal territory hepatectomy with an indocyanine green (ICG) fluorescent dual staining technique. Video: A 42-year-old man admitted to our center for a single hepatic mass at the end of segment 5. To test liver reserve function and locate the tumor, we intravenously administrated ICG (0.5 mg/kg) 5 days before the operation. The ICG-R15 of the patient was 4.1%. The Glissonian pedicles of target portal territory were approached and temporally clamped with Takasaki’s Glissonian method as discussed by Takasaki.2 Then, we intravenously administered ICG (1 mL, 5 mg/L) to negative stain the portal territory of segment 5 and expose biliary leak from the cut surface. Fusion ICG imaging of the tumor and positive fluorescent region were obtained using the PINPOINT image system (Stryker, Kalamazoo, MI). Liver parenchyma transection was performed alongside the boundary of negative fluorescence region using an ultrasonic scalpel and L-PMOD as reported by Cai et al..3 Since the tumor located at the junction of segments 5 and 8, we did some extended resection. Operative time was 195 min, and the estimated intraoperative blood loss was 100 mL. The patient was discharged on the seventh day, without any complications. HCC was confirmed in histopathology with a free margin (over 1.3 cm). No recurrence was noted in the follow-up period for 6 months after the operation. Laparoscopic anatomical S5 segmentectomy using portal territory hepatectomy strategy in a dual staining method was technically feasible and safe for patients with HCC located in segment 5.

Background Laparoscopic resections for submucosal tumors (SMTs) of the stomach have been developed rapidly over the past decade. Several types of laparoscopic methods for gastric SMTs have been created. We assessed the short-term outcomes of two commonly used types of laparoscopic local resection (LLR) for gastric SMTs and reported our findings. Methods We retrospectively analyzed the clinicopathological results of 266 patients with gastric SMTs whom underwent LLR between January 2006 and September 2016. 228 of these underwent laparoscopic exogastric wedge resection (LEWR), the remaining 38 patients with the tumors near the esophagogastric junction (EGJ) or antrum underwent laparoscopic transgastric resection (LTR). Results All the patients underwent laparoscopic resections successfully. The mean operation times of LEWR and LTR were 90.2 ± 37.2 min and 101.7 ± 38.5 min respectively. The postoperative length of hospital stays for LEWR and LTR were 5.1 ± 2.1 days and 5.3 ± 1.7 days respectively. There was a low complication rate (4.4%) and zero mortality in our series. Conclusion ELWR is technically feasible therapy of gastric SMTs. LTR is secure and effective for gastric intraluminal SMTs located near the EGJ or antrum.

Background Obesity is a growing epidemic around the world, and obese patients are generally regarded as high risk for surgery compared with normal weight patients. The purpose of this study was to evaluate the influence of obesity on the surgical outcomes of laparoscopic gastrectomy (LG) for gastric cancer. Methods We reviewed data for all patients undergoing LG for gastric cancer at our institute between October 2004 and December 2016. Patients were divided into non-obese and obese groups and the perioperative outcomes were compared. Furthermore, a subgroup analysis was conducted to evaluate which of the two commonly used methods of LG, laparoscopic-assisted gastrectomy (LAG) and totally laparoscopic gastrectomy (TLG), is more suitable for obese patients. Results A total of 1691 patients, 1255 non-obese and 436 obese or overweight patients, underwent LG during the study period. The mean operation time was significantly longer in the obese group than in the non-obese group (209.9 ± 29.7 vs. 227.2 ± 25.7 min, P

Although surgical outcomes of totally laparoscopic total gastrectomy (TLTG) have been reported from several centers, the effectiveness of this technique has not been conclusively established. The aim of this study was to investigate the feasibility, safety, and efficacy of TLTG for gastric cancer. A prospectively collected and retrospectively analyzed data were used by comparing the short-term surgical outcomes of 124 patients who underwent TLTG with those of 124 patients who underwent open total gastrectomy (OTG) between March 2007 and March 2016. The 2 groups were well matched with respect to age, sex, body mass index, ASA score, and tumor stage. There was no significant difference with regard to the operation time but TLTG showed significantly less intraoperative blood loss (115.5 ± 70.2 vs 210.5 ± 146.7 mL, P

Ancient anatomy made slow progress after it experienced two peaks of development in the Song dynasty. He Jian, a military doctor of the Ming Dynasty, observed diaphragm, heart, liver, gallbladder, bladder, throat and other human organs through autopsy. He wrote a book Yi Xue Tong Zong with his discoveries which were beyond those of his predecessors and also of WANG Qing-ren, a famous medical scholar of the Qing Dynasty, who was born 300 years later.

The curative effect of medicine is the principal one among so many factors that influence its spread. As an effective blood-stanching herb, Sanchi (Radix Notoginseng) is approved in nearly 20 years and is cultivated widely with its sources ensured.