Objective: This study aimed to share preliminary experiences of single-incision plus two ports laparoscopic proximal gastrectomy with right-sided overlap and single-flap valvuloplasty (ROSF). Methods: Following the 6th edition of the Japanese Gastric Cancer Treatment Guidelines, proximal gastrectomy with lymphadenectomy was performed. Using a single-port approach, the esophagus was transected at least 2 cm above the tumor's upper margin with linear staplers. The stomach was then extracted through a periumbilical incision, and the proximal stomach was subsequently transected extracorporeally, while ensuring appropriate resection margins on both the greater and lesser curvatures. A single flap was created before returning the remnant stomach to the abdominal cavity and re-establishing pneumoperitoneum. The No.2 clip was used to grasp and elevate the esophageal stump. An incision was made at the right lower edge of the esophageal stump to guarantee that the esophageal lumen was open. The linear stapler was then inserted into the openings of the stomach and esophagus to perform a side overlap anastomosis with a length of 3 cm. Another barbed suture was used to close the common opening of the esophagus and the stomach, and the same barbed suture were used to suture the gastric wall to the lower edge of the muscle flap. The first barbed suture was then used to sequentially suture the proximal brim of the flap to the esophagus and the right brim of the flap to the right brim of the mucosal window. After completion of anastomosis, a drainage tube was inserted through the right upper port. This procedure was employed from November 2023 to March 2024 on five patients diagnosed with adenocarcinoma of the esophagogastric junction and upper stomach. The cohort consisted of three males and two females, with an age range of 62 to 75 years and a body mass index (BMI) of 13.7 to 24.2 kg/m². All cases were preoperatively staged as T1-2N0M0, confirmed by endoscopic biopsy and enhanced CT scans of the chest, abdomen, and pelvis. Results: All five patients successfully underwent the surgery. The median surgery time was 180-325 minutes, with the intraoperative blood loss of 30-50 ml. The number of lymph nodes harvested ranged from 18 to 27. The time to first flatus, and restore liquid diet and was 2.0-5.0 and 1.0-3.0 days, respectively. The postoperative length of stay was 9.0-11.0 days. The pain scores on the Numeric Rating Scale (NRS). On the first day, the pain scores were 3.0 in two cases, 2.0 in two cases, and 1.0 in one case. On the second day, the pain scores were 2.0 in two cases and 1.0 in three cases. On the third day, the pain scores were 1.0 in four cases and 2.0 in one case. No short-term postoperative complications were observed, and there were no perioperative deaths. Conclusion: Single-incision plus two ports laparoscopic proximal gastrectomy with ROSF is safe and feasible.
目的： 分享应用单孔+2腹腔镜进行近端胃切除术中右开襟单肌瓣成形术（ROSF）的初步体会。 方法： 按照第6版日本《胃癌治疗指南》进行近端胃切除术与淋巴结清扫。经单孔腹腔镜组件插入闭合器，距离肿瘤上缘2 cm离断食管后，经脐切口将胃拉出体外，确保大小弯侧切缘，离断并切除近端胃，直视下进行右开襟单肌瓣的制作后，将胃还纳入腹腔。再次建立气腹。利用2号夹，夹持并上提食管断端。将胃黏膜窗近侧的胃浆肌层与距断端5 cm的食管后壁以倒刺线缝合3针。将食管断端闭合线的右下角切开，确切开放食管内腔。将闭合器分别插入黏膜窗右下角开口及食管右下角开口，行side overlap吻合，长度3 cm。以倒刺线缝合共同开口，并以同一倒刺线缝合胃壁与肌瓣下缘。将肌瓣右上角与食管缝合后，以第一根倒刺线将肌瓣上缘与食管、肌瓣右侧缘与胃壁进行连续缝合。经右上穿刺孔放置引流管。采用此方法于2023年11月至2024年3月期间，对明确诊断的5例食管胃结合部和胃上部腺癌患者进行了单孔+2腹腔镜近端胃切除ROSF。患者3男2女，年龄62~75岁，体质指数13.7~24.2 kg/m2。所有病例术前经胃镜病理活检和胸腹盆腔增强CT检查，术前肿瘤分期为T1~2N0M0。 结果： 5例患者均顺利完成手术。手术时长180~325 min，术中出血量30~50 ml，拣获淋巴结18~27枚。术后肛门排气时间2.0~5.0 d，恢复流质饮食时间为1.0~3.0 d，住院时间为9.0~11.0 d。术后疼痛数字评分量表（NRS）疼痛评分，第1天：2例3.0分，2例2.0分，1例1.0分；第2天：2例2.0分，3例1.0分；第3天：4例1.0分，1例2.0分。未发生术后短期并发症，无围手术期死亡。 结论： 单孔+2腹腔镜进行近端胃切除右开襟单肌瓣成形术安全可行。.