This work was supported by grants from the Scientific Research Project of the Health Commission of Hubei Province and the Xiangyang Key Project of Science and Technology in the medical and health field (2021YL15).

The operation followed standard procedures and received ethics approval. This study was permitted by the Ethics Committee of Xiangyang Central Hospital, affiliated with Hubei University of Arts and Science. Informed written consent was obtained from the patient. The research content and methods adhered to medical ethics norms and requirements. The reagents and equipment used in the study are listed in the Table of Materials.
1. Pre-surgical steps
<ol>
	<li>The patient was instructed to take oral sodium phosphate salt for bowel preparation one day before surgery. The patient fasted for 8 h and was allowed water intake up to 2 h before surgery. An upper gastric tube was inserted before entering the operating room.</li>
	<li>The patient was positioned in a supine split-leg position with the head elevated and slightly tilted to the right.</li>
	<li>Endotracheal intubation was performed, and general anesthesia was administered according to institutionally approved protocols.</li>
</ol>
2. Surgical procedure
<ol>
	<li>A transverse incision measuring 3.0-3.5 cm was created around the navel to insert the SILS port equipped with four in-built trocars (Figure 4A). An additional 12-mm trocar was inserted in the left upper quadrant to serve as an operative port for surgical instruments, including the ultrasonic shear, endoscopic linear stapler, and postoperative drainage tube.</li>
	<li>An ultrasonic knife was used to dissect the adipose lymphoid tissue of groups 1, 2, 3, 4, 7, 8a, 9, and 11p (Figure 5A,B). A lower esophageal segment length of approximately 5-7 cm was ensured (Figure 5C), and the freedom of the greater curvature and lesser curvature of the stomach was maintained. 
	NOTE: The SILT-DT procedure is shown in Figure 5. The stomach and lymph node dissection was performed in accordance with the Guidelines for Laparoscopic Surgery for Gastric Cancer (2023 edition)10. A D2 lymphadenectomy and proximal gastrectomy were completed.</li>
	<li>The esophagus-jejunum (EJ) anastomosis was established. The EJ anastomosis site was identified on the jejunum, 20 cm distal to the ligament of Treitz and near the lower esophagus. The EJ anastomosis was accomplished through the 12-mm port in the left upper quadrant using a 60-mm endoscopic linear stapler (Figure 5D). 
	NOTE: The schematic diagram illustrating the digestive tract reconstruction is shown in Figure 4B.</li>
	<li>A 60-mm endoscopic linear stapler was used to resect specimens of the esophagus and close the anastomotic opening between the jejunum and esophagus (Figure 5E).</li>
	<li>The gastrojejunal (GJ) anastomosis was created, with the site marked on the jejunum 8-15 cm distal to the EJ anastomosis and on the posterior wall of the greater curvature of the remaining stomach (Figure 5F).</li>
	<li>The jejunojejunal anastomosis was established. The jejunojejunal anastomosis was made through the 3.5-cm incision at the navel using a 60-mm endoscopic linear stapler, marking 5 cm distal to the GJ anastomosis site (Figure 5G).</li>
	<li>The individual anastomoses were closed and strengthened. Both the common openings of the GJ anastomosis and the jejunojejunal anastomosis were closed using a 3-0 micro Joe thread. The mesangial hiatus was closed with a continuous suture.</li>
	<li>A drainage tube was placed behind the EJ anastomosis and exited from the left upper abdomen (Figure 5H).</li>
</ol>
3. Postoperative management
<ol>
	<li>Postoperative water fasting was implemented, and the gastric tube was drained with an indwelling bag.</li>
	<li>The gastric tube was removed after 48 h of observation, ensuring no evident presence of bloody drainage fluid.</li>
	<li>Fluid infusion was administered to maintain water, electrolyte, and acid-base balance, along with acid suppression. The duration of prophylactic antibiotics was limited to a maximum of 48 h.</li>
	<li>Early mobilization was actively promoted within 6-24 h post-surgery. A liquid diet was initiated for 2-3 days during recovery.</li>
	<li>Anastomotic leakage was assessed, and the development of the residual stomach was evaluated through upper gastrointestinal radiography on day 7.</li>
	<li>The abdominal cavity drainage tube was removed within 5 to 7 days after hospital discharge.</li>
</ol>

<ol>
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Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Early+experience+of+duet+laparoscopic+distal+gastrectomy+(duet-ldg)+using+three+abdominal+ports+for+gastric+carcinoma:+Surgical+technique+and+comparison+with+conventional+laparoscopic+distal+gastrectomy.">Early experience of duet laparoscopic distal gastrectomy (duet-ldg) using three abdominal ports for gastric carcinoma: Surgical technique and comparison with conventional laparoscopic distal gastrectomy.</a> Surg Endosc. 30 (8), 3559-3566 (2016).</li><li>Kim, S. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+single-port+and+reduced-port+totally+laparoscopic+distal+gastrectomy+for+patients+with+early+gastric+cancer.">Comparison of single-port and reduced-port totally laparoscopic distal gastrectomy for patients with early gastric cancer.</a> Surg Endosc. 30 (9), 3950-3957 (2016).</li><li>Lee, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Learning+curve+of+pure+single-port+laparoscopic+distal+gastrectomy+for+gastric+cancer.">Learning curve of pure single-port laparoscopic distal gastrectomy for gastric cancer.</a> J Gastric Cancer. 18 (2), 182-188 (2018).</li><li>Omori, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+safety+and+feasibility+of+single-port+laparoscopic+gastrectomy+for+advanced+gastric+cancer.">The safety and feasibility of single-port laparoscopic gastrectomy for advanced gastric cancer.</a> J Gastrointest Surg. 23 (7), 1329-1339 (2019).</li><li>Kang, S. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-term+outcomes+of+single-incision+distal+gastrectomy+compared+with+conventional+laparoscopic+distal+gastrectomy:+A+propensity+score-matched+analysis.">Long-term outcomes of single-incision distal gastrectomy compared with conventional laparoscopic distal gastrectomy: A propensity score-matched analysis.</a> J Am Coll Surg. 234 (3), 340-351 (2022).</li><li>Lee, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intracorporeal+modified+delta-shaped+gastroduodenostomy+during+2-port+distal+gastrectomy:+Technical+aspects+and+short-term+outcomes.">Intracorporeal modified delta-shaped gastroduodenostomy during 2-port distal gastrectomy: Technical aspects and short-term outcomes.</a> Ann Surg Treat Res. 105 (3), 172-177 (2023).</li><li>Ahn, S. H., Park, D. J., Son, S. Y., Lee, C. M., Kim, H. 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The authors have no conflicts of interest or financial ties to disclose.

Single-port and reduced-port laparoscopic radical gastrectomy have become innovative approaches for treating gastric cancer and are steadily gaining acceptance. These techniques are receiving increased attention for their advantages, including improved cosmetic outcomes, reduced postoperative pain, a lower risk of surgical site infections, and faster recovery times.
The results of 12 studies involving 343 cases showed that single-port and reduced-port laparoscopic surgery was effective in treating distal gastric cancer, accounting for the majority of cases3,4,12,13,14,15,16,17,18,19,20,21. However, only four studies focused on total gastric resection22,23,24,25. These findings suggest that the clinical research and application of single-port gastric cancer surgery, particularly total gastrectomy, are limited due to the high surgical difficulty, the extensive dissection and lymph node removal required, and the complex technique of endoscopic digestive tract reconstruction.
We successfully performed the first laparoscopic proximal gastrectomy with double-tract anastomosis using a single incision plus one port for the treatment of proximal gastric cancer. Compared with traditional surgical methods, the single-incision plus one-port surgery is more minimally invasive. Relative to the single-port technique, the addition of the left upper abdominal port enhances convenience during the operation and allows for the rational placement of a drainage tube through an incision in the upper left abdomen.
Lee et al.26 reported the first case of single-port laparoscopic proximal gastrectomy with double-tract reconstruction for early gastric cancer in 2016. Compared to SILS, the single-incision plus one-port surgery includes an additional left upper abdominal port, creating a triangular structure composed of the umbilical region, left upper abdomen, and the surgical area. This innovative approach effectively addresses the limitations of pure single-incision surgery, such as inadequate anti-traction and linear visualization. Additionally, it enhances the flexibility of the surgeon&#39;s right-hand instrument, leading to significant improvements in operative efficiency and reduced complexity during each anastomosis under total laparoscopy.
Moreover, several strategies can enhance operational efficiency and reduce procedure duration. The surgeon may consider altering their positioning during lymph node dissection and digestive tract reconstruction, such as positioning themselves on the left side of the patient or between the patient&#39;s legs, to optimize exposure of the surgical area. For procedures like esophagojejunostomy and gastrojejunostomy, it is recommended that one assistant or the chief surgeon maintains a stable position while another performs docking, thereby improving anastomosis efficiency and minimizing the risk of tissue avulsion. Additionally, employing integrated laparoscopic instruments is advised to minimize interference between optical fibers and other instruments.
In summary, single-incision plus one-port laparoscopic proximal gastrectomy with double-channel anastomosis is feasible for treating proximal gastric cancer. In this case, the patient experienced a successful recovery. The operation is minimally invasive, and recovery is faster. However, the limitations of this protocol include the need for early-stage gastric cancer or benign gastric tumors, with the patient&#39;s BMI not being excessively high. The application of this protocol is not recommended for patients with locally advanced disease or high BMI due to the potential risk of positive tumor margins and increased surgical complexity. This protocol is still in the stage of technical exploration, with no established guidelines and insufficient clinical data to fully validate its long-term efficacy. The development of this protocol requires ethical approval from medical institutions and strict adherence to surgical indications. Further clinical research and exploration are necessary to determine the clinical applicability of the SILT-DT technique.

Laparoscopic techniques have recently become one of the main directions for the surgical treatment of gastric cancer1,2. The routine laparoscopic surgery for gastric cancer is mostly performed using the 5-hole method. With advancements in surgical techniques and continuous improvements in medical devices, reduced-port laparoscopic gastric cancer surgery has gradually developed to further reduce surgical trauma, minimize disturbance to the abdominal cavity, and accelerate postoperative recovery3,4,5,6.
Omori7 first reported single-port laparoscopic distal gastric cancer surgery in 2011. Pure single-port laparoscopic radical gastrectomy for gastric cancer is more difficult than traditional five-port laparoscopic gastrectomy. To address this, an auxiliary operating hole is added to the single-port laparoscopic procedure, which reduces the difficulty of the operation and facilitates the placement of an abdominal drainage tube8,9. Single-incision laparoscopic surgery plus one port (SILS+1), a minimally invasive technique for patients with gastric cancer, has gained popularity in recent years due to its reduced number of ports and shorter incision lengths.
Currently, single-port laparoscopic or SILS+1 gastric cancer surgery is relatively common in distal gastrectomy, while its application in total gastrectomy is rare. Additionally, the use of total laparoscopic double-tract gastric cancer anastomosis has not been reported.
Based on this, we first attempted single-port plus one-port total laparoscopic proximal gastrectomy with double-tract anastomosis (SILT-DT). The transumbilical port was used as the main operation port, and the left upper abdominal drainage port served as the auxiliary operation port. This technique was employed to perform proximal gastrectomy, D2 lymph node dissection, and double-tract anastomosis for digestive tract reconstruction.
CASE PRESENTATION: 
The patient, a 63-year-old male, was admitted to the hospital after a tumor was discovered at the esophagogastric junction during a gastroscopy (Figure 1). Biopsy results from the gastroscope suggested moderately differentiated adenocarcinoma (Figure 2). Preoperative chest and abdominal enhanced CT scans revealed no evidence of distant metastasis (Figure 3). The patient was previously healthy and had no history of abdominal surgery.
Patient selection 
Patients were eligible to participate if they had histologically confirmed Siewert type II or III gastroesophageal junction adenocarcinoma, with preoperative abdominal CT showing no enlarged lymph nodes around the stomach or distant metastasis. The maximum diameter of the tumor was required to be less than 3 cm, and the distance between the lower pole of the tumor and the gastric angle had to exceed 5 cm. Exclusion criteria included patients who had previously undergone abdominal surgery, those with a preoperative tumor diameter exceeding 3 cm and/or requiring multi-visceral resection, patients who had undergone multidisciplinary team (MDT) discussions regarding neoadjuvant chemoradiation, or those who had received neoadjuvant chemoradiation, and patients with intolerance to laparoscopic surgery.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>3D laparoscope</td>
			<td>KARL STORZ SE &#38; Co. KG</td>
			<td>26605BA</td>
			<td></td>
		</tr>
		<tr>
			<td>Absorbability surgical sutures</td>
			<td>Johnson &#38; Johnson</td>
			<td>TLBJXZ</td>
			<td></td>
		</tr>
		<tr>
			<td>Absorbable ligature clip</td>
			<td>Hangzhou KANGJI Medical Instrument co., LTD</td>
			<td>KJ-JZJ02ML</td>
			<td></td>
		</tr>
		<tr>
			<td>Disposable puncture device</td>
			<td>Hangzhou KANGJI Medical Instrument co., LTD</td>
			<td>Type IV sets F</td>
			<td></td>
		</tr>
		<tr>
			<td>Disposable step type endoscopic cutting stapler and nail bin</td>
			<td>Nanjing Maidixin Medical Device Co.,Ltd</td>
			<td>MLCR-Mb,MLCNC-60b-purple, MLCNC-45b-white</td>
			<td></td>
		</tr>
		<tr>
			<td>laparoscopic instruments</td>
			<td>Hangzhou KANGJI Medical Instrument co., LTD</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Ultrasound knife</td>
			<td>INNOLCON, Medical Science and Technology (suzhou) co., LTD</td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

single incision plus one port laparoscopic proximal gastrectomy with double channel anastomosis for gastric cancer treatment

Single-incision plus one-port laparoscopic proximal gastrectomy with double-channel anastomosis (SILT-DT) is a minimally invasive surgical approach for treating proximal gastric cancer. This technique includes comprehensive laparoscopic resection of the proximal stomach, lymph node dissection, and double-tract anastomosis. By integrating single-port laparoscopic surgery with an auxiliary operating hole, SILT-DT reduces procedural difficulty while facilitating the placement of an abdominal drainage tube. Compared to the traditional five-port laparoscopic gastrectomy, SILT-DT requires fewer ports and results in shorter incision lengths, contributing to reduced postoperative pain and faster recovery. A thorough preoperative evaluation was conducted to ensure procedural success, with factors such as tumor size, stage, location, and patient BMI carefully considered. This comprehensive assessment allowed for optimal patient selection and surgical planning. Postoperative follow-up demonstrated no significant complications, underscoring the safety and efficacy of SILT-DT. This innovative technique offers a promising minimally invasive alternative for managing proximal gastric cancer while maintaining excellent clinical outcomes.

The surgery was completed within 150 min, with minimal intraoperative bleeding of 5 mL. There were no short-term complications, and the patient&#39;s postoperative recovery was successful. A total of 24 lymph nodes were retrieved, and no lymph node metastasis was found. The operating time was 150 min, and the estimated blood loss was 5 mL. The patient remained in bed for 2 days. The time to first flatus was 70 h, and the patient began consuming liquid food and drinks after 3 days. The gastric tube was removed on the 4th day, and the drainage tube was removed within 7 days. The contrast agent persisted in the remnant stomach for 30-50 min without reflux into the esophagus (Figure 6). The cosmetic outcome of the postoperative abdominal incisions was satisfactory (Figure 4C). Pain was evaluated by an 11-point numeric rating scale (NRS) where 0 is no pain and 10 is the worst pain imaginable11. Detailed data for the patient are presented in Table 1.
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/67447/67447fig01.jpg" /> 
Figure 1: Gastroscopic images. <a href="https://www.jove.com/files/ftp_upload/67447/67447fig01large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/67447/67447fig02.jpg" /> 
Figure 2: The findings from the gastroscopic biopsy. The gastroscopic biopsy revealed a moderately differentiated adenocarcinoma. Scale bar: 50 &#181;m; magnification: 200x. <a href="https://www.jove.com/files/ftp_upload/67447/67447fig02large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/67447/67447fig03.jpg" /> 
Figure 3: Abdominal enhanced CT scans. Heterogeneous enhancement was seen in the cardia, which was considered as a neoplastic lesion, and the tumor did not invade the muscular layer. <a href="https://www.jove.com/files/ftp_upload/67447/67447fig03large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/67447/67447fig04.jpg" /> 
Figure 4: Surgical setup and postoperative wound condition. (A) Four in-built trocars used in the procedure. (B) Double-tract anastomosis performed during surgery. (C) Postoperative wound condition shown after the procedure. <a href="https://www.jove.com/files/ftp_upload/67447/67447fig04large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/67447/67447fig05.jpg" /> 
Figure 5: Surgical procedure details. (A,B) The process of cleansing the lymph nodes during the surgery. (C) Transection of the esophagus and opening of the lower esophageal end. (D) Side-to-side esophagojejunostomy performed as part of the anastomosis. (E) Closure of the common opening at the esophagojejunal anastomosis site. (F) Remnant gastrojejunostomy completed. (G) Side-to-side entero-intestinal anastomosis performed through the umbilical incision. (H) Position of the drainage tube. <a href="https://www.jove.com/files/ftp_upload/67447/67447fig05large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 6" class="xfigimg" src="/files/ftp_upload/67447/67447fig06.jpg" /> 
Figure 6: Upper gastrointestinal radiography. The upper gastrointestinal radiography showed that the anastomosis was open and the remaining stomach was clearly visible. <a href="https://www.jove.com/files/ftp_upload/67447/67447fig06large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Items</td>
			<td>Result</td>
		</tr>
		<tr>
			<td>Gender</td>
			<td>Male</td>
		</tr>
		<tr>
			<td>Year</td>
			<td>63</td>
		</tr>
		<tr>
			<td>BMI (kg/m2)</td>
			<td>23.5</td>
		</tr>
		<tr>
			<td>Anesthesia grade</td>
			<td>III</td>
		</tr>
		<tr>
			<td>Preoperative TNM-staging</td>
			<td>cT1N0M0</td>
		</tr>
		<tr>
			<td>Operation time (min)</td>
			<td>150</td>
		</tr>
		<tr>
			<td>Incision length (cm)</td>
			<td>2.8</td>
		</tr>
		<tr>
			<td>Intraoperative bleeding volume (mL)</td>
			<td>5</td>
		</tr>
		<tr>
			<td>Pathology</td>
			<td>moderately differentiated adenocarcinoma</td>
		</tr>
		<tr>
			<td>The distance of the proximal margin (cm)</td>
			<td>3.4</td>
		</tr>
		<tr>
			<td>The distance of the distal margin (cm)</td>
			<td>5.5</td>
		</tr>
		<tr>
			<td>Tumor size (cm)</td>
			<td>1.5*2*1.2</td>
		</tr>
		<tr>
			<td>The number of retrieved lymph nodes&#160;</td>
			<td>24</td>
		</tr>
		<tr>
			<td>&#160;TNM-staging</td>
			<td>pT2N0M0</td>
		</tr>
		<tr>
			<td>The duration of gastric tube removal after surgery (d)</td>
			<td>4</td>
		</tr>
		<tr>
			<td>The duration until the initial meal</td>
			<td>3</td>
		</tr>
		<tr>
			<td>The duration of bed activity</td>
			<td>2</td>
		</tr>
		<tr>
			<td>The duration to flatus (h)</td>
			<td>70</td>
		</tr>
		<tr>
			<td>The time for bowel movement (d)</td>
			<td>6</td>
		</tr>
		<tr>
			<td>The duration of the drainage tube (d)</td>
			<td>7</td>
		</tr>
		<tr>
			<td>Pain score on the first day after surgery</td>
			<td>2</td>
		</tr>
		<tr>
			<td>Postoperative hospital stay (day)</td>
			<td>8</td>
		</tr>
		<tr>
			<td>Complications</td>
			<td>None</td>
		</tr>
	</tbody>
</table>
Table 1: Perioperative data of the patient. Details regarding the perioperative data for the patient, including key measurements and outcomes.

The single-incision plus one-port laparoscopic proximal gastrectomy with double-channel anastomosis was initially employed for the radical resection of proximal gastric cancer. This study demonstrated the feasibility of the procedure and laid a foundation for further research.

Single Incision Plus One Port Laparoscopic Proximal Gastrectomy with Double Channel Anastomosis for Gastric Cancer Treatment

Single-incision plus one-port laparoscopic proximal gastrectomy with double-channel anastomosis (SILT-DT) is a minimally invasive surgical approach for ...

single-incision-plus-one-port-laparoscopic-proximal-gastrectomy-with

Research

JoVE Journal

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263 Views.  Affiliated Hospital of Hubei University of Arts and Science. The single-incision plus one-port laparoscopic proximal gastrectomy with double-channel anastomosis was initially employed for the radical resection of proximal gastric cancer. This study demonstrated the feasibility of the procedure and laid a foundation for further research.

Video: Single Incision Plus One Port Laparoscopic Proximal Gastrectomy with Double Channel Anastomosis for Gastric Cancer Treatment

Single Port Donor Nephrectomy

In 2007, Rane presented the first single port nephrectomy for a small non-functioning kidney at the World Congress of Endourology. Since that time, the use of single port surgery for nephrectomy has expanded to include donor nephrectomy. Over the next two years the technique was adopted for many others types of nephrectomies to include donor nephrectomy. We present our technique for single port donor nephrectomy using the Gelpoint device. We have successfully performed this surgery in over 100 patients and add this experience to our experience of over 1000 laparoscopic nephrectomies. With the proper equipment and technique, single port donor nephrectomy can be performed safely and effectively in the majority of live donors. We have found that our operative times and most importantly our transplant outcomes have not changed significantly with the adoption of the single port donor nephrectomy. We believe that single port donor nephrectomy represents a step forward in the care of living donors.

Single port laparoscopic surgery is changing the standard of care in surgical care like nothing since the laparoscopic technique was introduced 20 years ago. We present out technique of single port donor nephrectomy using the Gelpoint device. We have successfully performed this surgery in 100 patients.

In 2007, Rane presented the first single port nephrectomy for a small non-functioning kidney at the World Congress of Endourology.  Since that time, the ...

Murine Ileocolic Bowel Resection with Primary Anastomosis

Intestinal resections are frequently required for treatment of diseases involving the gastrointestinal tract, with Crohn&#8217;s disease and colon cancer being two common examples. Despite the frequency of these procedures, a significant knowledge gap remains in describing the inherent effects of intestinal resection on host physiology and disease pathophysiology. This article provides detailed instructions for an ileocolic resection with primary end-to-end anastomosis in mice, as well as essential aspects of peri-operative care to maximize post-operative success. When followed closely, this procedure yields a 95% long-term survival rate, no failure to thrive, and minimizes post-operative complications of bowel obstruction and anastomotic leak. The technical challenges of performing the procedure in mice are a barrier to its wide spread use in research. The skills described in this article can be acquired without previous surgical experience. Once mastered, the murine ileocolic resection procedure will provide a reproducible tool for studying the effects of intestinal resection in models of human disease.

Ileocolic resection is commonly performed in several human diseases; however, little is known regarding the impact of intestinal resection on surgical illnesses. This article provides instruction on executing the procedure in mice with high success, providing a means to study the effects of ileocolic resection in models of disease.

Intestinal resections are frequently required for treatment of diseases involving the gastrointestinal tract, with Crohn&#8217;s disease and colon cancer ...

Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma

Determining resection margins for gastric cancer, which are not exposed to the serosal surface of the stomach, is the most important procedure during totally laparoscopic gastrectomy (TLG). The aim of this protocol is to introduce a procedure for intraoperative gastroscopy, in order to directly mark tumors during TLG for gastric cancer in the middle third of the stomach. Patients who were diagnosed with adenocarcinoma in the middle third of the stomach were enrolled in this case series. Before surgery, additional gastroscopy for tumor localization is not performed. Under general anesthesia, laparoscopic mobilization of the stomach is performed first. After the first portion of the duodenum is mobilized from the pancreas and clamped, the surgeon moves to the other side for the gastroscopic procedure. On the insertion of a gastroscope through the oral cavity into the stomach, 2 - 3 cc of indigo carmine is administered via an endoscopic injector into the gastric muscle layer at the proximal margin of the stomach. The location of stained serosa in the laparoscopic view is used to guide distal subtotal gastrectomy, however, total gastrectomy is performed if the tumor is too close to the esophagogastric junction. A specimen is sampled after distal gastrectomy to confirm sufficient length from resection margin to tumor before reconstruction. In our case series, all patients had tumor-free margins and required no additional resection. There was no morbidity related to the gastroscopic procedure, and the time required for the procedure has gradually decreased to about five minutes. Intraoperative gastroscopy for tumor localization is an accurate and tolerated method for gastric cancer patients undergoing totally laparoscopic distal gastrectomy.

In early gastric cancer, the aim of surgery is to precisely remove the distal stomach including the primary tumor. To do this, accurate localization of the tumor is crucial, especially in totally laparoscopic surgery. This protocol describes a procedure for intraoperative gastroscopy in totally laparoscopic subtotal gastrectomy.

Determining resection margins for gastric cancer, which are not exposed to the serosal surface of the stomach, is the most important procedure during ...

Techniques of Sleeve Gastrectomy and Modified Roux-en-Y Gastric Bypass in Mice

Obesity is a major public health issue, with a prevalence of 4 to 28% for men and 6.2 to 36.5% for women in Europe (from 2003 to 2008). Morbid obesity is frequently associated with metabolic complications, such as type 2 diabetes, hypertension, and dyslipidemia, reducing life expectancy and quality. In the absence of any effective noninvasive treatments, bariatric surgery is a valuable therapeutic option for patients with morbid obesity (body mass index (BMI) &#62;40 kg/m2), leading to long-term, sustained weight loss and improvements in metabolic complications. However, the underlying cellular and molecular mechanisms sustaining the beneficial effects of bariatric surgery are not yet fully understood. Due to the numerous genetically-modified strains available, the mouse model is the most convenient animal model to explore the molecular mechanisms behind the pleiotropic beneficial effects of bariatric surgeries. Here, we detailed the optimized healthcare methods and surgical protocols in mice for the two most widely-used bariatric surgeries: the sleeve gastrectomy and the modified Roux-en-Y gastric bypass. Deciphering the molecular mechanisms underlying the therapeutic effects of bariatric surgeries offers the promise of identifying new therapeutics targets.

Bariatric surgery is the most efficient way to reduce body weight and the deadly metabolic complications (diabetes, obesity, and dyslipidemia) frequently associated with morbid obesity. Mouse models of bariatric surgery represent a unique asset for deciphering molecular mechanisms behind the beneficial effects of these surgeries on diabetes, hypertension, and dyslipidemia.

Obesity is a major public health issue, with a prevalence of 4 to 28% for men and 6.2 to 36.5% for women in Europe (from 2003 to 2008). Morbid obesity is ...

One-anastomosis Gastric Bypass (OAGB) in Rats

The goal of this protocol is to set up a preclinical model of bariatric surgery and, more specifically, OAGB in obese rats. Based on this preclinical model, longitudinal studies can be carried out to provide an improved understanding of the mechanisms underlying the outcomes seen after bariatric surgery in humans. For this purpose, rats are operated on through a laparotomy under general anesthesia with isoflurane. First, the surgeon creates a long and tubular gastric pouch: after greater curve and hiatal dissection, the nonglandular stomach is stapled and removed. Then, the remaining stomach is also stapled in order to create a gastric tube and exclude the antrum of the stomach. After that, the surgeon performs a single end-to-side gastrojejunostomy 35 cm from the duodenojejunal angle. This limb length has been chosen in order to reproduce the same ratio between the biliopancreatic limb (BPL) and common limb (CL) length as in human bariatric surgery. The operation ends by aponeurotic and cutaneous closure. The early postoperative management consists of subcutaneous hydration, an intramuscular prophylactic antibiotic injection, a parietal injection of xylocaine, the administration of painkillers, and a progressive reintroduction of diet.

One-anastomosis Gastric Bypass OAGB in Rats

This protocol is for the performance of one-anastomosis gastric bypass (OAGB) on rat. The operator performs a long and tubular-stapled gastric pouch followed by hand-sewn anastomosis. For this model, the operator reproduces the same ratio between biliopancreatic and common limb in humans; therefore, the biliopancreatic limb measures 35 cm.

The goal of this protocol is to set up a preclinical model of bariatric surgery and, more specifically, OAGB in obese rats. Based on this preclinical ...

Laparoscopy-endoscopy Cooperative Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumors

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this approach makes an innovative improvement in the treatment of G-GISTs that are less than 5 cm in size. Laparoscopy-endoscopy cooperative surgery (LECS) is used to combine endoscopic and laparoscopic surgeries, fully realizing their respective advantages and avoiding their drawbacks. The main steps are as follows. First, gastroscopy and laparoscopy are combined to confirm the location and boundary of the tumor. Tumor resection is carried out laparoscopically, guided by a gastroscope. The specimen is removed orally and the gastric wound closed laparoscopically. Then, gastroscopy and laparoscopy are combined to determine whether there is wound bleeding, if the suture is satisfactory, and if the gastric cavity is deformed.
LECS has natural advantages in the treatment of G-GISTs that are less than 5 cm in size. The accurate estimation of tumor location and boundary greatly improves the complete resection rate of tumors. The risk of tumor rupture is substantially reduced, and the long-term prognosis of patients is significantly improved. The process allows for accurate resection of the tumor, maximum preservation of normal gastric tissue and organ function, and avoids postoperative gastric deformation. The patient's postoperative rehabilitation is greatly accelerated, and oral feeding can resume on the day of the operation. The specimen is taken out through the mouth to avoid the need for an extended abdominal incision. This greatly reduces the patient's postoperative pain and scarring. The method greatly shortens the postoperative hospital stay (i.e., discharge is possible on the day after the operation), increasing the turnover of hospital beds.

Laparoscopy-endoscopy cooperative surgery is appropriate for the treatment of gastric gastrointestinal stromal tumors less than 5 cm in size. It can achieve the respective advantages of endoscopic and laparoscopic surgeries while avoiding their drawbacks.

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this ...

Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy Model in Mice

Obesity is a major health issue worldwide. As a response, bariatric surgeries have emerged to treat obesity and its related comorbidities (e.g., diabetes mellitus, dyslipidemia, non-alcoholic steatohepatitis, cardiovascular events, and cancers) through restrictive and malabsorptive mechanisms. Understanding the mechanisms by which these procedures allow such improvements often require their transposition into animals, especially in mice, because of the ease of generating genetically modified animals. Recently, the single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) has emerged as a procedure that uses both restrictive and malabsorptive effects, which is being used as an alternative to gastric bypass in case of major obesity. Thus far, this procedure has been associated with strong metabolic improvements, which has led to a marked increase in its use in daily clinical practice. However, the mechanisms underlying these metabolic effects have been poorly studied as a result of a lack of animal models. In this article, we present a reliable and reproducible model of SADI-S in mice, with a special focus on perioperative management. The description and use of this new rodent model will be helpful for the scientific community to better understand the molecular, metabolic, and structural changes induced by the SADI-S and to better define the surgical indications for clinical practice.

Single-anastomosis duodeno-ileal bypass (SADI-S) is an emerging bariatric procedure with important metabolic effects. In this article, we present a reliable and reproducible model of SADI-S in mice.

Obesity is a major health issue worldwide. As a response, bariatric surgeries have emerged to treat obesity and its related comorbidities (e.g., diabetes ...

Fluorescent Laparoscopic Central Hepatectomy for Liver Cancer Using Indocyanine Green Negative Staining

Laparoscopic hepatectomy is an important treatment method for liver cancer. In the past, the resection boundary was usually determined by intraoperative ultrasound, important vascular structures, and surgeon experience. With the development of anatomical hepatectomy, visual surgery technology has gradually been applied to this type of surgery, particularly indocyanine green (ICG)-guided anatomical hepatectomy. As ICG can be specifically ingested by hepatocytes and used for fluorescence tracing, negative staining techniques have been applied according to different tumor positions. Under ICG fluorescent guidance, the surface boundary and deep resection plane can be more accurately displayed during liver resection. Thus, the tumor-bearing liver segment can be anatomically removed, which helps to avoid damage to important vessels and reduce ischemia or congestion of the remaining liver tissue. Finally, the incidence of postoperative biliary fistula and liver dysfunction is reduced; therefore, a better prognosis is obtained after the resection of liver cancer. Centrally located liver cancer is usually defined as a tumor located at segments 4, 5, or 8 that requires resection of the middle section of the liver. These are among the most difficult hepatectomies to perform because of the large surgical wounds and multiple vessel transections. Based on the specific tumor location, we formulated the required resection ranges by designing personalized fluorescent staining strategies. By completing anatomical resection based on the portal territory, this work aims to achieve the best therapeutic effect.

The present protocol describes fluorescent negative staining in laparoscopic central hepatectomy. This technique can make hepatectomy more accurate and precise.

Laparoscopic hepatectomy is an important treatment method for liver cancer. In the past, the resection boundary was usually determined by intraoperative ...

Application of Laparoscopic Hepatectomy Combined with Intraoperative Microwave Ablation in Colorectal Cancer Liver Metastasis

Laparoscopic hepatectomy is a common treatment for colorectal cancer liver metastasis. Previously, a sufficient number of functional liver masses had to be maintained during laparoscopic hepatectomy, with a residual liver volume of &gt;40% in cirrhotic patients and &gt;30% in non-cirrhotic patients. The high incidence of complications such as bleeding, bile leakage, or liver failure due to the exposure and difficulty of the resection of specific liver segments such as S2 and S7 reduces the success rate of liver resection. At present, microwave ablation is mainly applied in the treatment of liver metastasis using a percutaneous approach, which makes it difficult to identify hidden parts or small lesions. For some liver segments, the percutaneous puncture of liver segment 7 (S7) is likely to pass through the thoracic cavity, and the percutaneous puncture of liver segment 2 (S2) adjacent to the diaphragm is likely to injure the diaphragm and heart; these issues restrict the application of percutaneous ablation in colorectal cancer liver metastasis. Considering multiple lesions, laparoscopic microwave ablation combined with hepatectomy was performed in this study. The location of the lesions was determined by contrast-enhanced ultrasound under laparoscopy, and small lesions that were difficult to detect before the operation were identified. For the scattered lesions, which had diameters less than 3 cm and were difficult to resect, ablation was adopted to substitute hepatectomy. This technique helped to more explicitly locate the tumors, simplified the operation procedures, reduced the risk of complications such as bleeding and bile leakage, shortened the operation time, accelerated the postoperative recovery, significantly improved the success rate of operation, and enhanced the clinical prognosis of colorectal cancer liver metastasis by surgical resection.

This protocol describes the laparoscopic resection of colorectal cancer liver metastases combined with ultrasound-guided microwave ablation. This technique can safely, effectively, and accurately treat refractory liver metastases &lt;3 cm, reduce postoperative complications, and accelerate the postoperative rehabilitation of patients.

Laparoscopic hepatectomy is a common treatment for colorectal cancer liver metastasis. Previously, a sufficient number of functional liver masses had to ...

Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction

Reduced-port laparoscopic surgery (RPLS) has been widely used for the radical resection of gastrointestinal tumors. Single-surgeon, three-port, laparoscopic radical resection for sigmoid colon or high rectal cancer with natural orifice specimen extraction surgery (NOSES) has the advantage of a small incision, quick postoperative recovery, and short hospital stay. Yet, there are still only a few reports on NOSES. This paper describes the indications, preoperative preparations, surgical steps, and precautions for single-surgeon, three-port, laparoscopic radical resection of the sigmoid colon and high rectal cancer, and intraoperative specimen collection through the natural orifice. 
The protocol focuses on the steps of radical dissection and the main technical points of resection and reconstruction. At the same time, a procedure for fixing an anvil seat by self-traction of extracorporeal silk thread, used for purse-string suture fixation after the proximal anvil was placed in the abdominal cavity, was creatively improved. This operation could effectively avoid problems such as an insufficient proximal intestinal tube, shaking off the anvil seat, and weak purse-string suture during a single operation. The surgical care had less variability and was easy to perform, effectively avoiding postoperative anastomotic leakage and bleeding due to excessive intraoperative anastomotic tissue. This surgery could be widely promoted in primary hospitals.

Here, we present a protocol to successfully perform single-surgeon, three-port, laparoscopic resection for colorectal cancer with natural orifice specimen extraction.