Application of Self-Pulling and Latter Transection in Totally Laparoscopic Total Gastrectomy

Background: To investigate the safety and efficacy of self-pulling and latter transection in totally laparoscopic total gastrectomy (SPLT-TLTG). Methods: Eighty patients with gastric cancer who received either SPLT-TLTG or laparoscopic-assisted total gastrectomy (LATG) were enrolled for this study from January 2016 to June 2018. Clinical data including clinicopathologic parameters, postoperative conditions and long-term prognosis were collected and compared between patients received different types of surgeries. Results: Compared to LATG, patients who received SPLT-TLTG surgery were associated with shorter operation time, less intraoperative blood loss and smaller incision lesion. In addition, patients who received SPLT-TLTG surgeries spent significantly less time in bed-rest post-surgically, to first bowel movement, hospital stay and before first oral food-intake (P < 0.05), as long as lower postoperative pain scores. However, no significant difference was observed between SPLT-TLTG and LATG surgeries in terms of how many lymph nodes (LNs) were retrieved during operation, as well as the overall incidence of postoperative complications (P > 0.05). Conclusions: This pilot study provided primary evidence for the application of self-pulling and latter transection in totally laparoscopic total gastrectomy in the treatment of gastric cancer.