Robotic-Assisted Proximal Gastrectomy with a Laparoscopic-Assisted Double-Tract Reconstruction for Proximal Early Gastric Cancer

1. Introduction

2. Access and Placement of Ports

3. Robot Docking

4. Exposure

1. Dissection of the Lesser Omentum
2. Ligation of Accessory Left Hepatic Artery
3. Liver Retraction

5. Stomach Mobilization and Lymph Node Dissection

1. Ligation of Left Gastroepiploic Artery and Vein
2. Ligation of a Short Gastric Artery
3. Lysis of Posterior Adhesions
4. Delineation of 3A and 3B Lymph Nodes

6. Stomach Transection

7. Further Lymph Node Dissection

1. Ligation of Left Gastric Artery and Vein

8. Esophageal Dissection

9. Robot Undocking

10. Esophageal Transection

1. Placement of Purse-String Suture on Proximal End of the Esophagus
2. Transection of Esophagus Distal to Purse-String Suture

11. Removal of Specimen

12. Specimen Dissection and Sending Full-Thickness Margins to Pathology

13. Changing Gloves

14. Double-Tract Reconstruction

1. Preparation of Esophagus for Stapled Anastomosis
2. Preparation of Jejunum for Double-Tract Reconstruction
3. Jejunojejunostomy
4. Gastrojejunostomy
5. Esophagojejunostomy
6. Final Views of Anastomoses
7. Fixation of Stomach Remnant

15. Hemostasis and Irrigation

16. Drain Placement

17. Closure

18. Post-op Remarks