hang Zhidong - Li Zhaoxing Total Endoscopic Radical Gastrectomy

Hi, dear colleagues, I'm here to present you the cases of a patient.

She is a woman of 40 years old and during the physical examination we didn't find any of the metastasis.

Right now we are going to do the disassociation under the laparoscopic.

Right now we are deploying the local manufactured, the Nanjing manufactured laparoscopy. The quality is really good.

Yes, we can hear you.

We can hear you.

Thank you very much for your greetings.

Any questions?

Good morning.

Thank you.

Welcome to us in Rome of 35 Congress.

Welcome, Professor.

I have a good image.

Can you explain to us what you are doing?

Of course.

他们现在给您打个招呼,给您打个招呼,他们那边是上午,所以说上午好,非常感谢您参加这次35,第35届相当于是手术直播在意大利罗马那边,所以现在就是看您的屏幕看得挺清楚的,然后您可以边做手术,来边跟他们解释一下现在一些手术的一些流程和一些步骤。

好的,好的。

Thank you, so I will give you more introduction during the process of the operation.

Professor Zhang is also expressing his personal excitement to get engaged in the thirty-fifth

operation live.

Thank you very much for your attendance.

Now we are seeing different movements.

For instance, now we are dissociating the gastrocollic ligament, and we are dissociating

the greater omentum.

Now we plan to have a D2 resection.

To avoid interoperative bleeding, we want to do some preparation to avoid the potential bleeding during the operation.

We see very well, but please, what is the pathology of the patient?

So here you're going to find the black mark.

This is where we did the mark before the operation.

This is a poorly differentiated endocasinoma with the score, with equal score at zero.

Thank you.

And we make it the GE, do the imaging result.

影像分析的话是一个TEBN0M0, that is the imaging staging, yes, T1BN0M0.

您这边的,张主任,您的这个手术的路是左侧进的吗,还是?

我手术站位,是吧?

对,是,就是。

对,我是站在病人的左侧。

Yes, I'm now at the left side of this patient, you're right.

现在我显示了病人的右膀左侧动脉。

Now we're also moving towards the left ventricle.

We are about to take the sandwich style.

The BMI of this patient is 24.

Now we're following the sandwich style.

In the beginning, we'll dissociate the omenta.

And finally, we will deal with the left aorta of the gastric cavity.

Now we move towards a great curvature.

So now we're looking at and we're deciding to dissociate the

omenta at the greater curvature of the stomach.

Yes, we decide to clump it.

Just now, I finished some section of the omenta on the great curvature side of the stomach,

and I did also complete the dissection of the 4SD belief node.

通常我们在这儿先放一个止血纱布,它呢又可以做我们一个减少肾血,另外也可以做我们一个手术的指引。

Right now, I'm going to place a gauze right here, this is going, this will help us to stop the bleeding and it will become a new mark, guiding us forward to the next step.

这是我们的筋膜,往这边。

For now, for most of the cases, we do not prefer to do the radical transsection of the

the Greater Aumenta of the Stomach by now for the specific demo case of the Thirty-Five

Life Operation we offered you the unique case of the Right Transaction of the Greater Aumenta.

Now we are opening the feature.

in.

Any questions, the floor is yours.

Please, how many doctors have you had in the patient, and what kind of work?

We have a very good team.

It was in 2D or 3D?

哦,就是想问一下您,就发现您这边的这个屏幕特别的清晰,咱们是2D的还是一个3D的呀?

是一个3D的,3D我们南京出格的场景。

So this is a 3, this is a 3 camera, very clear, it was produced by a Nanjing local supplier.

嗯,您这边是打了几个这个孔呢?

五个。

We have five pores on this patient.

Thank you.

Right here, we are dealing with the veins of the omentum.

This is the right gastric artery.

Now we plan to reset the artery and the veins in sync.

Again, I want to place a case right here.

Now, we plan to deal with the next site as we did before.

This is the left gastro-piglobulatory.

This is a coronary vein.

We decide to make the resection right now.

Still we are at the left gastric vein.

Now we are at the liver artery.

Now we are about to carry out the lymph node dissection right here.

Yes, I do recommend you have a gauze here.

Right now we are preparing to dissect the gastro duodenum, preparing for the next step.

Yes, we decided to dissect the artery and veins.

This is how we could ligate and transect the subproteodendrofessors and the arteries.

这是您一般在操作上手术的时候都会去处理右门上的东西吗?

Yes, this is my personal preference or personal habit to ligate and transect the supradendrofessors.

And I will resect the 2 cm or so duodenum.

And this is the right gastric artery and veins.

I need several clips.

Right here we can see very clearly about the portal base and right here we are about to

carry out the group 12, leave no dissection.

First of all, we will legate and dissect the left gastric vein.

The reason why we are deciding to legate the left gastric vein is to dissect the group

Group 9 and Group 2 lymph nodes.

Yes, this is the portal vein.

Now we are arriving here.

Now we can find out.

We have already completed the Group 9 lymph node dissection.

Right now, we're following this wing artery to carry out the rest of the lymph node dissection.

This is a group 11, the proximal lymph node dissection.

Now we are seeing the auditory variations.

We just assume we experienced the artery bleeding.

Our computer saw a very nice, fast and clean line from the dissection.

But no renal angiogenesis.

Sorry, can you repeat the question?

I cannot hear clearly.

Why don't you utilize the green indioxanine, the color green indioxanine, for the decontamination?

So in our practice, we were doing the fluorescence tagging or labeling for some of the patients

and the cases.

But for these specific cases, this equipment does not have the fluorescence labeling, so

we don't use that.

But for the rest of the cases, we may offer the fluorescence tagging of the blood vessel

source of the fluorescent-guided surgery, or we could also use some other tools, but

not for this specific operation.

Thank you.

Thank you.

Thank you.

Thank you for your explanation.

Now we're moving to the angle of the stomach and offering the lymph node dissection.

Here we did a little bit of a rotation.

Yes, we need two blue clicks.

Yes, I need the thicker one, the bigger clips.

So we just completed the entire process of lymph node dissection.

Now we're moving directly to the tumor.

This is patient of the early stage, around stage 1.

In order to save time to carry out interoperative gastroscopy,

we did the marking before the surgery.

That's why we could now deal with the tumor.

Since through all the preoperative examination,

this patient is still stage 1 patient,

we believe that a 3cm margin is good enough.

Yes, we're mobilizing the Omenta.

I want to show with you the entire picture.

This is inferior, this is a place below the adiagentive, and let's see it clearly.

This is a common hepatic artery below, within this sublibrary region, and we have dissected

Group 9 dissections not very far away from the right gastric artery.

They left no dissection just beside the splenic artery.

This is the surrounding of the left gastric artery.

Now we are going to get our samples and examine clearly about the size of the margin.

We will take out the samples and we need one more piece of the gauze.

We still have the light in place.

This is an incision around 3 to 5 centimeters.

Excuse me, please widen and enlarge one port for this rational spaceman.

想问一下咱们为什么这边要重新再打一个正的口子啊?

咱们这边为什么要重新打一个口子啊?

好,行

So this is the port for the sample being taken out

The tumor sample was removed through the port

这个渍和大概我们量一下,4.5公分

It is the 4.5 centimeters of the diameter.

This is a lesion of less than 2 centimeters in terms of the diameter.

The margin is around, the upper margin is 6 centimeters.

5 to 6.

Yes, 5 to 6 centimeters below the lesion, a good enough margin.

We will have the pathologist.

We see well, thank you.

And after the sample being removed, we'll use this port, this incision, to carry out

the J-drill, J-drill after me.

That is how we are going to complete the construction of the cancer cavity.

I need a middle-sized clip of 2.5 centimeters.

It is 10 cm away from the incision of the ostomy.

We will carry out the manual suturing.

This is the reverse insertion line, with a 4, a 0, and a 5.

Again, we are about to re-establish the normal peritoneum.

Yes, we need to make one more incision at the great curvature side to complete the final

Yes, we found that the great culture side is below, it's at the below side.

Yes, we will uplift these small intestinal.

Get closer, get them closer.

It's sliced down.

Yes, well, let's get closer to each other.

Yes, you can't shut this small intestinal.

The great curvature side.

Loosen the curvature side.

Grab this small intestinal.

Move it slowly.

It's almost done.

Still we are using the 4-0 reverse searching line to complete the process of manual searching.

Do you mean by, do they, will they carry out the cleaning of the surgery?

Hello there, hi there, any questions and comment?

Now we're about to end up this operation.

We took around 90 minutes or so, one and a half hour, to complete this surgery.

According to our estimation, in the entire process of the operation,

only 10 centimeters of the blood has been lost.

We need more clips here.

Let's cut this one.

According to our experiences, the stapler is of high quality, it is of the unequal height

of the design of the stapler, and we are going to do a final checking of if there is any

bleeding or not. If there's no more bleeding, we're about to close the operation.

I need to find out the original gauze. We may still use it.

Now we need to find out the last piece of the gauze as long as we identify the last

piece of gauze we will immediately end up this surgery.

So we just give you the brief introduction about the stapler.

The brand of this stapler is the Panson.

It is a non-equal height stapler.

So thank you very much for the watching. Thank you for the online audiences. This is the

end of the operation.

Thank you, Professor Zhang. Thank you to see your interest in the next question. Thank

you from Chairman of the Congress, Professor Palazzini. And also thank you to Madam Ter-Lid

Thank you very much.