STOMACH > Laparoscopic D2 Radical Gastrectomy

Patient and Port position: Patient placed in modified Lloyd Davies position
Pneumoperitoneum created by veress needle through 10 mm Supraumbilical skin incision which later on is converted into 10mm camera port.  LUQ & RUQ ports – 12cm, epigastric, left anterior axillary and RIF ports -5mm ports made.

Initial step is to visualize all quadrants of peritoneal cavity, liver surfaces and primary tumor location for metastasis, lymphadenopathy and ascites.

Omentum divided from transverse colon. Lesser sac entered.  Left and right gastroepiploic vessels and right gastric artery clipped and divided. Duodenum (D1) dissected circumferentially and divided by endo GIA stapler (blue). Periportal along with common hepatic artery, celiac and splenic artery lymphnodes dissected. Left gastric vessels dissected, clipped and divided at their origin. Proximal gastric division done by endo GIA stapler (blue) proximal to left gastric artery insertion over lesser curvature. Roux-en-Y loop created by endo GIA (white) stapler by dividing jejunum 15cm distal to DJ flexure. Antecolic GastroJejunostomy (GJ) was done by endo GIA stapler (blue).  Stapled Jejunojejunostomy  (JJ) done 60cm distal to GJ.  Enterotomies closed by 3-0 PDS sutures.