Laparoscopic radical total gastrectomy and reconstruction

A 59 year old male patent with cT3N1+ M0 gastric cancer underwent laparoscopic radical total gastrectomy. Operative procedures: Firstly, to dissect the gastrocolic ligament, and to dissect anterior lobe of transverse mesocolon. Second, to expose and cut the right vein of the gastric omentum at the root, with clearance of NO.14v lymph nodes, and to expose the gastroduodenal artery, and to cut the right artery of the gastric omentum at the root, with clearance of NO.6 lymph nodes. Third, to dissect capsule of pancreas, with clearance of NO.7, 8 and 9 lymph nodes, to expose the portal vein under the common hepatic artery with clearance of NO.12a lymph nodes. Then to expose the gastroduodenal artery, proper hepatic artery and to cut the right gastric artery with clearance of NO.5 lymph nodes. To clear NO1 .lymph nodes after release liver and gastric ligaments to the right side of the cardia. Fourth, to explore along the splenic artery, expose the blood vessels of the splenic portal area, with clearance of NO.10, 11 lymph nodes. and to dissect the left side of the cardia, with clearance of NO.2 lymph nodes. At last, reconstruct the digestive tract was achieved by using Roux-en-Y anastomosis through small abdominal incision. Key words: Stomach Neoplasms; Laparoscopy; Gastrectomy