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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_536_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Preface
- •Contents
- •1.6 Lymphatics
- •1.7 Innervation
- •Contributors
- •1 Surgical Anatomy of the Esophagus
- •1.1 Introduction
- •1.2 Composition
- •1.3 Fixation
- •1.4 Topography
- •1.5 Arteries and Veins
- •References
- •2 A Concentric-Structured Model for the Understanding of the Surgical Anatomy in the Upper Mediastinum Required for Esophagectomy with Radical Mediastinal Lymph Node Dissection
- •2.1 Introduction
- •2.2 Surgical Anatomical Model
- •2.3 Validation of the Surgical Procedure
- •References
- •3 A Surgical Concept for the Subcarinal Anatomy of the Esophagus and Mediastinum
- •3.1 Introduction
- •3.2 Surgical Anatomical Observation
- •References
- •4.1 Description of the Surgical Technique
- •4.1.1 Patient and Trocar Position
- •4.1.2 Position a Liver Retractor
- •4.1.3 Opening the Pars Flaccida of the Gastrohepatic Ligament
- •4.1.4 Incision of the Oesophago-Phrenic Ligament
- •4.1.9 Keep Track of the Vagal Nerves
- •4.1.10 Start of the Suturing of the Crus
- •4.1.11 Fundus Pull Through
- •4.1.12 Suturing of the Fundus and Creation of the Fundoplication
- •4.1.13 Checking and Ending
- •References
- •5 Laparoscopic Nissen Fundoplication
- •5.1 Introduction
- •5.2 Description of the Surgical Technique
- •5.2.1 Patient and Trocars’ Position
- •5.2.2 Exposure of Operative Field
- •5.2.3 Start the Intervention
- •5.2.5 Taping of the Esophagus for Retraction
- •5.2.6 Mediastinal Dissection and Esophagus Mobilization
- •5.2.7 Construction of Floppy Wrap
- •5.2.8 Crural Opposition
- •5.2.9 Construction of Fundoplication
- •5.2.10 Completed Procedure
- •References
- •6 Minimally Invasive Surgery of Paraesophageal Hernias
- •6.1 Introduction
- •6.2 Description of the Surgical Technique (Video 6.1)
- •6.2.1 Instruments and Equipment Required
- •6.2.2 Patient and Trocars’ Position
- •6.2.4 Division of the First Short Vessels
- •6.2.5 Dissection of the Sac, from the Left Crus Anti-Clockwise from Left to Right
- •6.2.6 Dissection Continues to the Dome of the Hiatus and the Right Crus
- •6.2.7 The Sac (and Lipomas) is Completely Dissected from Mediastinum into the Abdominal Cavity
- •6.2.8 Mobilization of the Esophagus by Pulling Down the Sac
- •6.2.9 Creation of a Retroesophageal Window
- •6.2.10 Approximation of the Pillars Using a Bougie (Foucher) for Calibration
- •6.2.11 Mesh Placement
- •6.2.12 Creation of 360 Degrees Fundoplication
- •References
- •7 Minimally Invasive Treatment of Esophageal Leiomyoma
- •7.1 Introduction
- •7.2 Description of the Surgical Technique (See Videos 7.1 and 7.2)
- •References
- •8 Peroral Endoscopic Myotomy (POEM) for Achalasia
- •8.1 Introduction
- •8.3.1 Post-Procedural Management
- •References
- •9 Laparoscopic Heller Myotomy and Dor Fundoplication for Treatment of Esophageal Achalasia: Surgical Technique
- •9.1 Background
- •9.2 Surgical Technique. Step by Step
- •References
- •10 Endoscopic Treatment of Early Esophageal Cancer
- •10.1 Introduction
- •10.2.1 Lift-Suck-Cut Technique
- •10.2.2 Ligate-And-Cut Technique
- •10.2.3 Endoscopic Submucosal Dissection
- •References
- •11 Transmediastinal Approach for Esophageal Cancer: Upper and Middle Mediastinal Dissection with Single-Port Technique
- •11.1 Introduction
- •11.2.1 Surgical Team Members
- •11.2.2 Left Cervical Procedure
- •11.2.5 Esophageal Reconstruction
- •11.2.6 Postoperative Management
- •11.3 Conclusions
- •References
- •12 Laparoscopic Transhiatal Resection for Distal Esophageal and Gastro-Esophageal Junction Cancer
- •12.1 Introduction
- •12.2 Description of the Operative Technique
- •References
- •13 Robot-Assisted Minimally Invasive Transhiatal Esophagectomy
- •13.1 Introduction
- •13.2 Description of the Surgical Technique
- •13.2.2 Patient and Trocar Position
- •13.2.3 Mobilization of the Stomach and Esophagus
- •14 Minimally Invasive Esophagectomy: Ivor Lewis
- •14.1 Introduction
- •14.2 Description of the Surgical Technique (see Video 14.1)
- •14.2.1 Laparoscopic Phase
- •14.2.2 Thoracoscopic Phase in Prone Position (Single-Lumen Tube)
- •13.2.6 Gastric Conduit Creation and Passage Through the Posterior Mediastinum to the Neck
- •13.2.7 Narrowing the Hiatus
- •13.2.8 Cervical Esophagogastric Anastomosis According to Orringer
- •References
- •15 Thoracoscopic Radical Oesophagectomy for Cancer
- •15.1 Introduction
- •15.2 Thoracoscopic Mediastinal Dissection
- •15.2.1 Surgical Anatomy of Mediastinum with Reference to the Oesophagus
- •15.3 Description of the Surgical Technique (see Video 15.1)
- •15.3.2 Mobilization of the Dorsal Aspect of the Oesophagus
- •15.3.3 Mobilization of the Ventral Aspect of the Oesophagus
- •15.3.4 Dissection of the Left Recurrent Nodes
- •15.3.5 Dissection of the Tracheobronchial Nodes
- •References
- •16 Three-Stage McKeown Minimally Invasive Esophagectomy Procedure in Prone Position
- •16.1 Introduction
- •References
- •17 Robot-Assisted Minimally Invasive Esophagectomy (RAMIE)
- •17.1 Introduction
- •17.2.1 Thoracoscopic Preparation and Positioning
- •17.2.2 Thoracoscopic Phase: Operative Procedure
- •17.2.3 Laparoscopic Phase: Positioning
- •17.2.4 Laparoscopic Phase: Operative Procedure
- •17.2.5 Cervical Phase
- •17.3 Future Directions
- •17.4 Hand-Sewn Intrathoracic Anastomosis and Upper Esophageal Cancer
- •17.5 The Steps to Perform an Intrathoracic Gastroesophageal Anastomosis (see Videos 17.1–17.3)
- •17.6 cT4b Esophageal Cancer
- •17.7 Conclusion
- •References
- •18 Cervical Esophagogastric Anastomosis
- •18.1 Introduction
- •18.2 Description of the Operative Technique (see Video 18.1)
- •18.3 Stapled Anastomosis
- •18.4 Hand-Sewn Anastomosis
- •References
- •19.1 Introduction
- •19.2 Description of the Surgical Procedure (see Video 19.1)
- •19.3 Thoracoscopic Phase in Prone Position
- •20.1 Description of the Operative Procedure (see Video 20.1)
- •21.1 Description of the Operative Procedure (see Video 21.1)
- •References
- •22.1 Description of the Surgical Procedure (See Video 22.1)
- •Reference
- •Reference
- •24.1 Description of the Surgical Technique (See Video 24.1)
- •References (References 2 and 3 could be deleted)
- •25 Surgical Anatomy of the Stomach and the Omental Bursa
- •25.1 Introduction
- •25.2 Anatomical Features
- •25.3 Structure
- •25.4 Topographical Relationships
- •25.5 Vascular Supply
- •25.6 Lymphatic Drainage
- •25.7 Innervation
- •25.8 Omental Bursa
- •References
- •26 Minimally Invasive Treatment of Gastric GIST
- •26.1 Introduction
- •26.2 Description of the Surgical Technique
- •26.2.1 Transgastric Resection
- •26.2.2 Transgastric Resection
- •References
- •27 Minimally Invasive Surgery for Treatment of Complications of Gastroduodenal Ulcer
- •27.1 Introduction
- •27.2.1 Ulcer Perforation
- •27.2.2 Bleeding
- •27.2.3 Stenosis
- •References
- •28 Laparoscopic Adjustable Gastric Band
- •28.1 Introduction
- •References
- •29 Laparoscopic Roux-En-Y Gastric Bypass
- •29.1 Introduction
- •29.2 Description of the Surgical Technique (Video 29.1)
- •References
- •30 Laparoscopic Sleeve Gastrectomy
- •30.1 Introduction
- •30.2 Description of the Surgical Technique (Video 30.1)
- •References
- •31 Laparoscopic Duodenal Switch
- •31.1 Introduction
- •31.1.1 Description of the Surgical Technique (Video 31.1) [1]
- •References
- •32 Single Anastomosis Duodenoileal Bypass with Sleeve Gastrectomy
- •32.1 Introduction
- •References
- •33 Endoscopic and Minimally Invasive Surgical Treatment of Early Gastric Cancer
- •33.1 Introduction
- •33.1.1 Laparoscopic Distal Gastrectomy
- •33.1.2 Description of the Operative Technique (Videos 33.1 and 33.2)
- •33.1.3 Postoperative Management
- •33.1.4 Tips, Tricks, and Pitfalls
- •33.2.1 Description of the Operative Technique (See Video 33.1)
- •References
- •34 Laparoscopic Partial Gastrectomy for Gastric Cancer
- •34.1 Introduction
- •34.2 Clinical Staging and Surgical Plan
- •References
- •35.1 Introduction
- •35.2 Description of the Surgical Technique (See Video 35.1)
- •References
- •36 Robotic Distal Gastrectomy for Gastric Cancer
- •36.1 Introduction
- •36.2 Indication
- •36.3 Description of the Surgical Steps (See Video 36.1)
- •References
- •37 Laparoscopic Total Gastrectomy for Gastric Cancer
- •37.1 Introduction
- •37.2 Clinical Staging and Surgical Plan
- •37.4 Reconstruction After Total Gastrectomy
- •References
- •38 Spleen-Preserving Splenic Hilar Dissection for Proximal Gastric Cancer
- •38.1 Introduction
- •References
- •39 End-To-Side Esophagojejunal Anastomosis Using the Circular Orvil Device
- •39.1 End-To-Side Esophagojejunal Anastomosis Using the Orvil Device
- •References
- •40 Hand-Sewn Anastomosis After 95% Gastrectomy, Total Gastrectomy, and Total Gastrectomy Extended to the Distal Esophagus for Gastric Cancer
- •40.1 Introduction
- •References
- •41 Robot-Assisted Total Gastrectomy for Gastric Cancer
- •41.1 Description of the Surgical Procedure (See Video 41.1)
- •References
- •42.3 Laparoscopic Total Gastrectomy with D2 Lymph Node Dissection
- •42.4 Robotic Gastrectomy
- •References
- •43 Final Considerations
- •43.2 Permanent Learning
- •43.3 Progress
- •Index

M. Asunción Acosta
Miguel A. Cuesta
Marcos Bruna Editors
Atlas of
Minimally Invasive
Techniques in Upper
Gastrointestinal Surgery

Atlas of Minimally Invasive Techniques in Upper
Gastrointestinal Surgery

M. Asunción Acosta · Miguel A. Cuesta ·
Marcos Bruna
Editors
Atlas of Minimally Invasive
Techniques in Upper
Gastrointestinal Surgery

Editors
M. Asunción Acosta
Unidad de Cirugia Esofago-gàstrica, Hospital
Universitario de Gran Canaria “Dr. Negrìn”
Las Palmas, Gran Canaria, Spain
Marcos Bruna
Department of Surgery
Hospital Universitario y Politècnico La Fè
Valencia, Spain
Miguel A. Cuesta
Department of Surgery
Amsterdam University Medical Centre (UMC)
Amsterdam, The Netherlands
ISBN 978-3-030-55175-9 ISBN 978-3-030-55176-6 (eBook)
https://doi.org/10.1007/978-3-030-55176-6
© Springer Nature Switzerland AG 2021
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is
concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction
on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation,
computer software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not
imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and
regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed
to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty,
expressed or implied, with respect to the material contained herein or for any errors or omissions that may have
been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional
affiliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Quiero dedicar este Atlas a mi marido, Rafael. Él es
la fuente de mi felicidad, mantiene en pie mi preciosa
familia y permite que yo vuele ...
I want to dedicate this Atlas to my husband, Rafael.
He is the source of my happiness, he holds down my
precious family, and he allows me to fly ...
M. Asunción Acosta
I would like to thank my wife Ineke Radder for her
unconditional support and patience, and dedicate
this work to all our patients without whom this Atlas
would not have happened.
Miguel A. Cuesta
To my family and masters for being always close to
me and giving to me so many wonderful things.
Marcos Bruna

Preface
Since the first interventions of laparoscopic antireflux surgery in the early 1990 our interest
has been the implementation of minimally invasive procedures in all Upper Gastrointestinal
(Upper GI) pathology, benign and malignant.
Surgeons continually strive to provide the best care possible for their patients. This focus
on enhancing the quality of surgery brings them to employ the Minimally Invasive Surgery
(MIS) approach. Doing so, they try to reduce postoperative pain, lower the risk of postoperative complications and increase quality of life.
Surgeons have in the past decades demonstrated major progress in improving surgery. We
have seen diagnostic invasive procedures replaced by a variety of imaging techniques providing high-resolution insight in the anatomical aspects of the disease, thereby allowing surgical
teams to refine their surgical indications and approaches. Based on this better imaging we
have seen the development of endoscopic treatments in early cancers, but also image-guided
percutaneous placement of stents or drains for relieving obstructions or fluid collections that
impede the recovery of patients.
And finally, we have seen large abdominal incisions and extensive resections with huge
blood losses replaced by minimal incisions and gentle dissection with minimal blood loss,
thus allowing patients to ambulate very early after surgery and reassume their activities
within days instead of long postoperative stays in the hospital. Moreover the fast track concepts have broken the conservative ideas of perioperative treatments, making the process of
every surgical intervention a piece of objectiveness based on evidence.
Hence it is no surprise that Minimally Invasive Surgery is currently the standard surgical
treatment in almost all areas of Abdominal Surgery, such as gallbladder surgery, the whole
benign gastrointestinal surgery, including bariatric surgery, esophageal, gastric and colorectal
cancer surgery.
Studies do continue to determine the quality of MIS. To be sure, the notion that Minimally
Invasive procedures in Upper GI Surgery, especially the oncological processes, are as efficient or even better than their counterpart of Open Surgery, still follows different phases of
becoming evident. For some procedures, like esophageal resection and partial gastrectomy
for cancer the evidence of the supremacy of MIS is now reasonably certain. High evidence
even suggests that MIS may be superior to the counterpart open resections by providing clearer short-term advantages and equal oncologic safety. Other procedures, such as
total gastrectomies, hepatic resections and duodenopancreatectomies for pancreatic head
cancer are still subject to high-level studies and big data analysis for determining how
evidence-based these standard procedures are. In benign diseases, evidence that MIS is better
than the conventional is given by high evidence studies and big data analysis with the conclusion that MIS procedures are safe and better in outcomes.
Significant is that the introduction of high-definition imaging, 3D technology and
robot-assisted surgery demonstrate the advantages of having a better visualization and ergonomy. These techniques involve the capacity to dissect and reconstruct tissues in difficult to
locate places and suffice with a relative short learning curve. But the improvements in surgery are constantly moving forward. The concept that collected big data of high digital imaging may facilitate processes of artificial intelligence in the surgical interventions is gaining
in acceptance. Using these improvements we should create more efficient and safe surgical
vii

viii Preface
paths for optimal oncological resections in a near future. Despite successes, Upper GI MIS
procedures remain difficult to standardize because of the complicated and tortuous surgical
anatomy and due to the limited numbers of patients, undergoing these procedures, exception is the bariatric surgery, in comparison with for example the high numbers in colorectal
surgery.
The objective of an Atlas like this in comparison with a standard book of surgery is to
offer after a short introduction to the issue the key steps of operative technique schematic
accompanied by clear illustrations, operative photo’s and videos.
Despite the body of this ATLAS is formed by bariatric and oncological surgery of esophageal and gastric cancer all other Upper GI diseases are depicted here. The philosophy we
follow is that once a good indication is made for surgery, optimal peroperative preparation of
the patients is paramount for an optimal outcome. In oncological processes the combination
of an optimal use of neoadjuvant therapy, if indicated, with Minimally Invasive Surgery will
achieve the best outcome for the patient offering a high quality of life.
Our objective in this ATLAS is to depict the current situation of Minimal Upper GI
Surgery , benign and oncological. By doing so, we demonstrate how to perform these procedures with the minimum risk for the patients and simultaneously obtaining as many advantages as is feasible.
The setup for this book has two sections: the esophageal and the gastric surgery. Each
section starts with a chapter dedicated to surgical anatomy followed first of all by different
chapters on benign pathology, endoscopic treatment and chapters dedicated to different techniques available for cancer surgery. Other chapters treat the specific operative techniques of
MIS, whereby the robot-assisted minimally invasive surgery and near infrared technology is
used.
Knowledge of surgical anatomy is very important for each surgeon and helps to standardize the use of convenient dissection planes and to perform a standard oncological resection.
The call for achieving higher proficiencies in MIS is clear. Mastering the MIS procedures
is arduous and may take time. We realize that surgeons and their teams dedicated to Upper
GI surgery may have to gain proficiencies involving a lengthy learning curve while under the
control and assistance of a master.
Moreover, readers of this book will be aided by a well-chosen collection of videos that
describe the accomplishment of the surgical procedures in MIS.
Our gratitude for the splendid contributions of all authors is great. Their dedication to the
design and implementation of the procedures treated in this volume is encouraging.
We hope that this book will enrich the knowledge and understanding of surgeons and surgical residents around the world whom are dedicated to Upper Gastrointestinal Surgery and
will inspire these professionals to persist in improving on surgery.
Las Palmas, Spain
Amsterdam, The Netherlands
Valencia, Spain
M. Asunción Acosta
Miguel A. Cuesta
Marcos Bruna

Contents
1 Surgical Anatomy of the Esophagus ................................... 1
Teus J. Weijs and Ronald L. A. W. Bleys
2 A Concentric-Structured Model for the Understanding of the Surgical
Anatomy in the Upper Mediastinum Required for Esophagectomy with
Radical Mediastinal Lymph Node Dissection ............................ 9
Hiroyuki Daiko
3 A Surgical Concept for the Subcarinal Anatomy of the Esophagus and
Mediastinum ...................................................... 13
Miguel A. Cuesta
4 270 Degrees Fundoplication for Gastroesophageal Reflux Esophagitis ....... 19
Ivo A. M. J. Broeders
5 Laparoscopic Nissen Fundoplication ................................... 29
Bernard Dallemagne
6 Minimally Invasive Surgery of Paraesophageal Hernias ................... 39
Salvador Morales-Conde, Francisco Lopez Bernal and Isaías Alarcón
7 Minimally Invasive Treatment of Esophageal Leiomyoma ................. 47
Donald. L. van der Peet and Miguel A. Cuesta
8 Peroral Endoscopic Myotomy (POEM) for Achalasia ..................... 51
Barbara A. J. Bastiaansen, André J. P. M. Smout and Paul Fockens
9 Laparoscopic Heller Myotomy and Dor Fundoplication for Treatment of
Esophageal Achalasia: Surgical Technique .............................. 55
Eduardo M. Targarona, Sonia Fernandez Ananin and Carmen Balagué Ponz
10 Endoscopic Treatment of Early Esophageal Cancer ...................... 61
Bas L. A. M. Weusten
11 Transmediastinal Approach for Esophageal Cancer: Upper and Middle
Mediastinal Dissection with Single-Port Technique ....................... 71
Hitoshi Fujiwara, Atsushi Shiozaki, Hirotaka Konishi and Eigo Otsuji
12 Laparoscopic Transhiatal Resection for Distal Esophageal and Gastro-
Esophageal Junction Cancer ......................................... 89
Miguel A. Cuesta and Donald L. van der Peet
13 Robot-Assisted Minimally Invasive Transhiatal Esophagectomy ............ 99
Rishindra M. Reddy
14 Minimally Invasive Esophagectomy: Ivor Lewis ......................... 109
Misha Luyer and Grard Nieuwenhuijzen
ix

x Contents
15 Thoracoscopic Radical Oesophagectomy for Cancer ..................... 121
Harushi Osugi, Kousuke Narumiya and Kenji Kudou
16 Three-Stage McKeown Minimally Invasive Esophagectomy Procedure in
Prone Position ..................................................... 131
Fernando Mingol Navarro, M. Asunción Acosta, Marcos Bruna
and Miguel A. Cuesta
17 Robot-Assisted Minimally Invasive Esophagectomy (RAMIE) ............. 143
Richard van Hillegersberg, Pieter C. van der Sluis and Jelle P. Ruurda
18 Cervical Esophagogastric Anastomosis ................................. 153
M. Asunción Acosta and Salvador Navarro Soto
19 Intrathoracic Esophago-Gastrostomy After MIE Ivor Lewis Esophageal
Resection: End-To-Side Anastomosis by Means of Circular Stapler. The Flap
and Wrap Technique ................................................ 159
Suzanne S. Gisbertz and Mark I. van Berge Henegouwen
20 Intrathoracic Oesophago-Gastrostomy After MIE Ivor Lewis Resection:
Side-To-Side Oesophago-Gastrostomy by Means of a Linear Stapler ........ 163
Misha Luyer and Grard Nieuwenhuijzen
21 Intrathoracic Esophago-Gastrostomy After MIE Ivor Lewis Resection:
End-To-Side Anastomosis by Means of a Circular Stapler and Endoloop .... 171
Fernando Mingol Navarro
22 Intrathoracic Esophago-Gastrostomy After MIE Ivor Lewis Resection:
End-to-Side Anastomosis Using a Double Endoloop System ............... 181
Camiel Rosman and Bastiaan Klarenbeek
23 Intrathoracic Esophago-Gastrostomy After MIE Ivor Lewis Resection:
End-To-Side Hand-Sewn Anastomosis ................................. 191
Guy-Bernard Cadiere and Benjamin Cadiere
24 Intrathoracic Robot-Assisted Minimally Invasive Esophagectomy (RAMIE)
Ivor Lewis End-To-Side Anastomosis .................................. 195
Ismael Diez del Val and Carlos Loureiro González
25 Surgical Anatomy of the Stomach and the Omental Bursa ................. 201
Ronald L. A. W. Bleys and Teus J. Weijs
26 Minimally Invasive Treatment of Gastric GIST .......................... 207
Carlos Moreno-Sanz and Miguel A. Cuesta
27 Minimally Invasive Surgery for Treatment of Complications of
Gastroduodenal Ulcer ............................................... 215
José A. Ramírez, M. Asunción Acosta and Marcos Bruna
28 Laparoscopic Adjustable Gastric Band ................................. 221
Jaime Ponce
29 Laparoscopic Roux-En-Y Gastric Bypass ............................... 229
J. Caetano Marchesini and Natan Zundel
30 Laparoscopic Sleeve Gastrectomy ..................................... 237
Michel Gagner
31 Laparoscopic Duodenal Switch ....................................... 243
Jacques Himpens and Roel Bolckmans

32 Single Anastomosis Duodenoileal Bypass with Sleeve Gastrectomy .......... 249
Andrés Sánchez-Pernaute, María Elia Pérez Aguirre and Aida Pérez Jiménez
33 Endoscopic and Minimally Invasive Surgical Treatment of Early Gastric
Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
Noriyuki Inaki
34 Laparoscopic Partial Gastrectomy for Gastric Cancer .................... 271
Antonio Talvane Torres de Oliveira, Croider Franco Lacerda, Paulo A. Bertulucci
and Miguel A. Cuesta
35 Modified Billroth-I Delta-Shaped Anastomosis After Distal Gastrectomy .... 279
Takahiro Kinoshita
36 Robotic Distal Gastrectomy for Gastric Cancer .......................... 285
Young-Woo Kim and Won Ho Han
37 Laparoscopic Total Gastrectomy for Gastric Cancer ..................... 299
Antonio Talvane Torres de Oliveira, Croider Franco Lacerda, Paulo A. Bertulucci
and Miguel A. Cuesta
38 Spleen-Preserving Splenic Hilar Dissection for Proximal Gastric Cancer .... 311
Takahiro Kinoshita
39 End-To-Side Esophagojejunal Anastomosis Using the Circular Orvil Device .... 317
Suzanne S. Gisbertz and Mark I. van Berge Henegouwen
xiContents
40 Hand-Sewn Anastomosis After 95% Gastrectomy, Total Gastrectomy, and
Total Gastrectomy Extended to the Distal Esophagus for Gastric Cancer .... 323
Juan Santiago Azagra, Beniamino Pascotto, Luca Arru, Francisco Javier Ibañez,
Silviu T. Makkai-Popa and Martine Goergen
41 Robot-Assisted Total Gastrectomy for Gastric Cancer .................... 333
Felix Berlth and Han-Kwang Yang
42 Laparoscopic Immunofluorescence-Guided Lymphadenectomy in Gastric
Cancer Surgery .................................................... 343
Woo Jin Hyung and In Gyu Kwon
43 Final Considerations ................................................ 365
M. Asunción Acosta, Miguel A. Cuesta and Marcos Bruna
Index ................................................................. 367
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