Yan Chao L. Radical resection of distal gastric cancer

Now we are directly into the second operation, and this is the gallbladder we are moving into.

It seems to us that there is a little bit of adhesion.

Be patient, I will deal with it.

A small clip

Very good position

Hello, Professor Yan Chao, can you hear me?

Yes, we can hear you very clearly.

Okay, thank you for being with us in the realm of 35 years of laparoscopic surgery.

Thank you to Madam Liz.

I see she's an interpreter.

Can you...

Yes.

Thank you.

What are you doing now, please?

Oh, good.

Professor Yan, can you...

I'll make a brief introduction.

Okay, fine.

Okay.

Dear professors and colleagues,

we are honored to have the opportunity

to display a digital gastric cancer surgery

a distal gastroectomy with standard D2 lymph node dissection.

First, I will introduce the patient's information.

She is 61 years old.

The height is 160 centimeters and 48 kilograms.

BMI is 18.8.

The chief medical complaint is acid reflux with upper abdominal discomfort for more than one year

and weight loss for two months.

And the gastroscopic examination is the gastric enteral mucosal lesion disease with 0 to B or to C.

The results of the pathologic exam is intramucosal signet ring cell carcinoma.

We also performed the gastric cancer staging CT scan.

The clinical stage is T122M0.

Yesterday, the patient was conducted and injected with a tracer nanocarbon in stomach tumor lesion.

to mark the location of the tumor,

and help increase lymph node dissection.

Now, let's watch the video.

I'm sorry, Professor Yan has performed the surgery

for some minutes.

Now, we introduce the surgery group.

The chief surgeon is Professor Yan Tao.

The first assistant surgeon is Dr. Yang Zongying.

And the second assistant surgeon is Lu Sen.

Now, watch the video.

Thank you.

So in the past, we followed the approach of the posterior pathway or the posterior approach.

But now we prefer to have the mixture, the posterior approach together with the posterior approach.

and we prefer to do the transsection of the duodenum.

So now we're showcasing the region of the 8A lymph node,

the gommahepatic artery, as well as the GDA.

The purpose is to find out and identify the white gas to the vessels in the first place

before we can complete the entire D2-link node dissection.

这个地方要当心,我们不要损伤我们肝肿动脉。

So this is a place we have to do the gentle operation,

because we want to avoid any damage on the common hepatic artery.

这是肝肿动脉,这是肝固有动脉,

然后这是胃有血管。

我们擦擦镜头有点脏了。

So this is a place we are going to share with you

the region of the comahepatic artery

as well as the proper hepatic artery.

Now we are seeing the residue

of the right gastric artery.

And I placed a clip right here.

And I want to leave a small opening here to ensure the anterior approach, still invisible.

This is a superior artery of the duodenal.

We could deal with it through the posterior approach or anterior approach.

Now we decide to dissect and transect the superior pancreatinal duodenal artery through

the posterior approach right here we have very clear field divisions through the anterior approach

so we are going to have a successful transaction of this small momentum

Yes, we are going to get closer, get deeper, to have a better view.

Since there are several branches of the superior pancreas acting on the dendro artery, so we

prefer to have more transection. I need a hemostatic clip as well.

Yes, I did another transection for 1-2 branches of the superior pancreas

antical duodendral arteries that is how i can do this for transaction

let me do this

然后呢,我们就准备离断,我们就准备离断这个杀蚀场。

Now we have fully completed the group 5 and group 6 means no dissection,

and that is how we could successfully mobilize the duodenum.

好,跟大背肌,大背肌,背肌。

Be patient.

还有对上面的脾气。

那我们要找个合适的位置,然后把杀蚀场离断。

I need to find a good position to better mobilize the duodenum.

我们今天用的是电动枪,是我们中国产的电动枪。

Today, we are honored to have the electronic stapler made by our Chinese brand.

教训,教训,教训,这上面都看不清楚。

哎,很好。

Yes, we need better focus to have better view.

在离站十二指堂,我喜欢用蓝钉。

当然有的同道喜欢用白钉。

Person speaking, I prefer to use up the blue chips to carry out the mobilization of the duodenum,

but for some of my colleagues, they prefer the white clips.

在这个地方,它走速比较慢,这样的话,它是打得比较均匀。

In my experiences, this stapler is not that fast.

我们可以看看稍微上残端,稍微上残端是不是需要加固呢?

long time. I find it goes very smoothly despite the fact that it's not that fast. It could give

me a very stable performance. Since this is a patient of the stage 1 and stage 2, I do not

prefer to give it another round of stapling because of the good tissue situations. But when I

carry out the open surgeries for the stage 3 and stage 4 patients, I would prefer to re-stabilizing

this patient. However, for this patient, there's no need for me to do re-stippling.

Don't do that.

Yes, good, good, good.

Good, good.

See your focus, we want to do.

We want a better view.

Good, good.

Good, good.

Be gentle.

Yes, go gentle, please, go gentle.

Good, good, good.

垂直垂直

往上看

大家轻轻的

方向保持

不要紧

终于表达

我现在有

可以

可以

好行

先把这个

这是胃左静脉,这里就是冠状静脉,我们要把它线一段点。

Yes, this is left gastric vein, also named as the coronary gastric vein.

We want to do the mobilization in the first place.

这边,这边,你先给我。

对,对,对,好的,好的。

Wait, this is a great tool for the new septum process.

I need a smaller hemlock.

继续。

在这里呢,在我们尾巴系,喜欢用两个,两个hemlock。

I prefer to use a pair of the hemlock.

因为静脉的这个,有时候夹得不牢固,它会脱掉。

I want to avoid the loss or the loosening of the hemlock in the vein.

这样我们位着静脉就断掉了。

That is how I can do the successful transsection of the left gastroblane.

这边我们看到的是脾动脉。

Right now, we should find clearly the location of the spleen artery,

and we are about to dissect the group 11 lymph nodes.

According to general knowledge, we have to expose the splenic veins

before we are going to carry out the lymph node dissection.

But for this specific patient, I don't think that is a necessary step, because everybody

has different contour of the veins and arteries.

Actually, we want to find out the division, the division line of the 11P and 11D lymph

node. However, normally we will follow the posterior gastric vessels, but the posterior

gastric vessels are not to be found in every patient.

Actually, I cannot say it is the posterior gastric vessels. Definitely, I'm not that

But I feel that it is the right vessel I'm going to target.

So that is how and that is the moment I can deal with UFMP and UFMD lymph node dissection.

At the moment, we have completed the 11-P lymph node dissection.

This is one of the angles.

这样的话,我这里就清扫完了,我们来看看。

这是整个脊动脉。

这是脊动脉。

然后我们可以看到这是一个肤腔干在跳动,然后这是胃组的动脉。

这个区域我们就清扫好了。

这样的话,我们就处理这边,处理右侧,胃组动脉的右侧。

The counterpart, the white gastric artery.

I discussed about the differences and the combined therapy of the posterior and anterior

approach.

Personally speaking, I prefer the anterior approach together with the transsection of

the duodendral, because that is going to save me better view as well as a larger space for

the operation.

Move it a little bit further, don't get that close.

Now we change approach for the left gastric artery.

We found a bit of a stent.

Good. Good move.

That's how we have the same.

Yes, this is how we have successfully transect the left gastric vein,

and we have completed the dissection of the group 7 lymph nodes.

Now we want to do the hard job.

We will move directly to the upper margin of the pancreatitis.

This is a region that we find is highly complex, and it is easy for us to cause bleeding.

We have to be very careful.

And we are not going to speak too highly of the teamwork.

That is something superb.

This is the 12A lymph node.

Now we will be exposed to the port of A.

Yes, the port of A has been fully exposed.

By exposing the port of A,

we could be in a better position

to dissect the 12A lymph node.

After we successfully

reset the 12A lymph nodes,

we will go and deal with

the group 9 lymph nodes.

At the right-hand side,

the group 9 is very much close to

8P lymph nodes.

这地方呢,我们在彻底清扫淋巴液的同时呢,要预防淋巴漏。

And we want to avoid, yes, we want to avoid the lymph node effusion.

Be focused, we want to have better focus during the operation.

可以看到,因为这是淋巴液也都漏出来了。

Now we are seeing the lymph node effusion.

可以了,好。

所以我们最后,我喜欢,可以最后用我们的血管胶把它夹掉。

但避免手术以后的淋巴肉。

I want to avoid any happening, any occurrence of the lymph node fusture,

so that is why I prefer to use a hemlock to avoid the happening.

大家可以看到,我们这后面是8P的,

然后这个后面我们从门进来后方拉出来的就是12P,

我们不在跟外的范围之内,我们也不需要清扫,

所以说在这个地方我常常会用夹子夹掉,可以说夹。

Behind the portal vein, we'll find out the 12P lymph nodes,

but it is not involved, so I do not prefer to do the dissection.

Instead, I prefer to use a hemlock to get it away.

再来一个,可惜说讲。

I need one more.

The absorbable leg.

因为这里是12P的灵感灵,我们不需要清掃,我们就把它讲掉。

This is a trough peel.

If it knows we are not going to do a dissection, we just give it a click.

大家可以看到我们打完以后就全部倒掉了。

So that is how we have successfully cleave or dissect all the lymph nodes.

Here is the entire anatomy, we could have the view, the splenic artery, the left...

So we are very much careful about dissection of the group 12 lymph nodes as well as the

group 9 lymph nodes, because that is the two major groups of lymph nodes we are going to

avoid future recurrence or relapse, and we are going to expose the portal veins as well

as the proper hepatic arteries.

This is Group 1 and Group 3, who have our Indigeneity section.

This is the last step for us to carry out the Indigeneity section.

This is the last step, but still we have to be very cautious, because we want to avoid

any chances of bleeding.

Yes, let's move to the abdominal side a little bit.

Yes, let's move to the caudal side and abdominal side.

Yes, let's turn it around, rotate it.

We could find out the very small lymph nodes through the laparoscopic camera.

It is very clear for us to see.

And now we just did the penetration from the posterior approach,

and we get a better view in the anterior approach.

In my personal practices, I do not prefer to use the full leg to do the ligamentation.

I prefer to use two serves of the leg to carry out the surgeries and the performances.

Now we have completed the group 1 and group 3.

Let's go and check the position of the nanoparticle.

This is the nano nanoparticle mark.

Yes, this is the nanoparticle.

Yes, everything is good.

Yes, let's make the other position right here.

And the great curvature, we want to leave more space.

And we also want to find out the blood supply, we want to check if it is a good enough supply, blood supply.

If we have very good and sufficient blood supply, we can leave more space, we can have a better margin.

We are going to do the resection

Transsection

I will handle this

I will take up this piece

Nice job

This is the resection line

Yes, we are finding, we are concluding a very smooth anastomosis line.

Don't hurry, be patient. We will move it step by step.

I'll take it, I'll do it by myself.

usually we are going to find out the pathology examination results to decide on the emergence

not usually we'll place it at the enteral side the entron but if it is a patient with

atropic gastritis we'll get it much bigger in terms of the incision

这样我们就完成了淋巴液清扫和胃的离断。

我们大概保留了三分之一的胃。

我们会进行开副,把这个标本取出来,

然后我们再进行开放的时候,

我们通过取标本的小气口进行肠肠吻合,

然后在腔间内完成胃肠吻合。

So now we are going to open a new incision and take out the samples.

After that, we are going to do the intestinal asthmagnosis.

A 5-centimeter incision is being made right now.

大家可以看到我们这个棺槽孔是在旗上的,我们就延长这个棺槽孔就可以了。

Actually, we did this musician just above the observational court. It is above the ambivalent court.

这是我们标记的地方,这是胃肚骨的一个肿瘤,是纳米肝标记的一个地方的肿瘤。

我们切除了三分之二的胃肚骨,我们切除了三分之二的胃肚骨。

To offer better anastomosis, I now shifted to the right side of the patient,

while before the anastomatosis, I was standing at the left side of this patient.

Yes, now we have already identified the upper section of the jejunen.

First of all, we are going to do the jejunen and jejunen ostomatosis.

We are going to close up this opening right now.

I need to be calm and force this.

Again, we are going to perform the general ostomy and the general anastomosis.

Right now, we are doing the non-transsected extracorporeal anastomosis in the path.

We prefer to have the C4 anastomosis.

You could choose either of the approaches to carry out the anastomatosis,

either by the traditional way of the underlaparoscopy,

but I prefer to do the extracorporeal anastomosis.

One of the major steps in the entire process

of the non-transsected extracorporeal anastomosis

is to rebuild the valve.

I need the 3-5 sutures.

一般的顶点,这个也是个薄弱区域,所以我加固一阵。

It's the top, the apex is also a vulnerable place, so I need to give it an extra fill.

这是我们的空场,这是收入盘,然后这是我们的长长吻合。

然后我就是要做一个阻断,阻断我们都是用丝线的,以前可以用吻合器,没有不带刀片的吻合器。

现在我们就是常规用这种办法。

This is how we are going to do the...

大家可以看到,我们就是一个支线,然后呢,加上这样一个硅胶管。

This is a silk suture with a silicon tube.

这样可以避免切割。

To avoid any guarding damage.

这也是为什么我更喜欢在枪外做长枪管和地链。

And the reason why I choose a silk suture as well as a silicon tube

is also one of the main reasons why I prefer to use the extra corpule anastomosis.

I want to replace it back to abdominal cavity.

I want to replace, I want to make a change for a new pair of the gloves.

And now it is the right time for us to build a new more peritoneum because we want to realize

the final step of the ostomosis between the intestinal and the stomach.

It takes us about 14 seconds before we can...

depleted the establishment of the pneumoperitoneum.

As of now, we have preserved three to four of these stumps

to ensure better blood supply, so I find it is very good.

So we want to find

and identify different

anatomic positions.

这样的话没有张力,那么我们就进行这样的一个温和。

因为这个胃呢,相对来讲是足够的,

所以说呢,如果胃不足了,胃这个,它胃比较小,

我会选择在这里打共同开阔的临临。

因为这个胃,胃裂还是比较充裕的,

那我会点在这里。

在这里呢,这样呢,我们这个相对来讲血管就会比较好。

We want to check the tension to ensure the proper anastomosis,

And we are also identifying the size as well as the thickness, the size of the stomach as well as the thickness of the water, and I want to make it in the middle of the water.

Go stable, I'll handle it.

Yes, stretch it, take it, stretch it.

We're all going to open it.

用我的吧,用我的。

好的,上面一点,我要把它打开。

好,可以,好,可以啊,好。

把胃拉出来。

Stretch on the stomach.

你没有那个,你看看。

Be careful to loosen this small intestinal

You take care of this small intestinal

I will handle the stomach

没关系,没关系

来个小的handlock

I need a small handlock

剪刀

I need scissors

我们再看看

这样我们就处理得蛮好的

我们看看有没有顺序

Yes, we're going to check if there's any bleeding or infiltration of the blood.

Now is the right time for me to carry out the manual suturing.

For some cases, I would use a stapler,

stapler, but for this specific case, I prefer to use a suture.

I used up the two lines to close up the function opening.

It's more like a cross-over approach.

But sometimes I would also practice the manual suturing during the robotic-assisted operation.

And we could also do this during the laparoscopic-assisted surgery.

There, I could not see very clearly due to the poor focus.

Again, let's turn around.

Yes, I will use the other direction to carry out the suturing.

我们同日有同道,也觉得一根可以缝到底就可以了,但是我还是喜欢交叉,这样更牢固一点。

For some of my colleagues, they may prefer just a single piece of the line to carry out the suturing,

but for me, I prefer to use the crossover-bubbed suture to close the incision after the gastric suturing.

So I just received a question from the online audiences.

It is asked that when they carry out lymph node dissection,

would it be possible for me to generate an aneurysm?

So it can prevent the flow of the lymph nodes.

For me, we would perform very gently during the process of the lymph node dissection and it is

almost impossible for me to generate any aneurysm because when I carry out the dissection, I will

preserve the aventure. We are not going to get out of the aventure. We will deal with

with the dissection and we will also preserve the functions, the outermost layer of the

blood vessels and then the t-cells will be preserved to avoid any occurrence of aneurysm.

No, we have no question, but thank you very much for allowing us to see your operation

with some very interesting skills.

Thank you also from Professor Pazzini

to sit with us on this Congress.

And again, thank you to Madame Litt for the translation.

Thank you very much.

感谢主帮我们的邀请,感谢我们主持人的介绍,感谢我们整个团队,还有我们翻译老师的辛苦工作。

Thank you very much for staying with us, and we are almost getting to the last step of this operation.

We are almost done, and thank you very much for the organizing committee to have us on this online meeting,

and thank you for the working staff to make it happen, and thank you for the interpreter to make this happen.

And we have a couple of one step

to have the tube being inserted for this patient.

No problem.

Okay, thank you, Ms. Tong Chuan.

We have basically finished the surgery.

So we will end the interview here.

We will just rinse it off and rinse it off later.

Yes, we will offer the final step of the drainage

to take care of this patient.

And we will also clean up all this space

Thank you very much for staying with us.

好的,谢谢啊。

那我们今天的演示就到此圆满结束。

Let's call it a day.

Thank you very much for staying with us for the last few hours.

See you.

See you again.

也谢谢各位,谢谢我们团队的展示。