Laparoscopic procedures are increasingly being applied to gastric cancer surgery, including total gastrectomy for tumors located in the upper gastric body. Even for expert surgeons, esophagojejunostomy after laparoscopy-assisted total gastrectomy (LATG) can be technically challenging. We perform the overlap method of esophagojejunostomy after LATG for gastric cancer. However, technical questions remain. Is the overlap method safer and more useful than other anastomosis techniques, such as methods using a circular stapler? In addition, while we perform this overlap reconstruction after LATG in a deep and narrow operative field, can the overlap method be performed safely regardless of body habitus? This study aimed to evaluate these issues retrospectively and to review the literature.

Situs inversus totalis is a relatively rare condition and is an autosomal recessive congenital defect in which an abdominal and/or thoracic organ is positioned as a “mirror image” of the normal position in the sagittal plane. We report our experience of laparoscopic-assisted total gastrectomy with lymph node dissection performed for gastric cancer in a patient with situs inversus totalis. A 58-year-old male was diagnosed with cT1bN0N0 gastric cancer. There were no vascular anomalies on abdominal angiographic computed tomography with three-dimensional reconstruction. laparoscopic-assisted total gastrectomy was performed with D1+ lymph node dissection, in accordance with the Japanese Gastric Cancer Treatment Guidelines. There were no intraoperative issues, and no postoperative complications. This was the first report describing laparoscopic-assisted total gastrectomy with the standard typical lymph node dissection in the English literature. We emphasize that the position of trocars and the standing side of the primary surgeon during the lymph node dissection are critical.

Laparoscopic transverse colectomy is challenging due to the technical difficulties in identifying an adequate dissection plane, ligating, and dissecting lymph nodes around the middle colic vessels. One of the reasons for the technical difficulties is the complex relationship between the middle colic vein (MCV) and its tributary. So, defining the venous anatomy around the MCV before laparoscopic surgery seems important to avoid massive bleeding. The purpose of this study was to evaluate the depiction rate and variation of the MCV and its tributaries on three-dimensional computed tomography angiography (3DCTA). This study included 331 patients (203 men and 128 women) scheduled for laparoscopic surgery between June 2010 and April 2012. Most of the patients had gastric or colorectal cancer. Patients who needed emergency surgeries for obstruction or perforation were excluded. 3DCTA with an intravenous contrast medium was performed immediately following administration of effervescent granules or room-air insufflation. We assessed variations of the MCV tributaries using trans-axial, multi-planer reconstructed images and volume-rendering images. The MCV could be identified in all patients. The MCVs drained into the superior mesenteric vein in 62.5% of patients, gastrocolic trunk of Henle in 29.3%, inferior mesenteric vein in 4.8%, splenic vein in 2.7%, and jejunal vein in 0.6%. 3DCTA is useful to evaluate anatomic variants of the MCV in preoperative planning for laparoscopic surgery. Use of 3DCTA for recognition of the anatomic complexity around the MCV and its tributary plays an important role in preoperative planning for optimal patient outcome.