Laparoscopic Mediastinal Approach to Total Gastric Tube Resection for Gastric Tube Cancer Through a Retrosternal Route

Background As a minimally invasive procedure for gastric tube cancer through a retrosternal route, we have previously reported a total resection of the gastric tube combined with a laparoscopic-assisted mediastinal approach (Abe T et.al, Annals of Gastroenterological Surgery, 2021). In this method, a gastric tube inversion technique was added to secure surgical space in the narrow retrosternal space. In the present report, we reported a retrosternal gastric tube resection with a laparoscopic mediastinal approach to further minimize invasiveness and improve operability. Methods A 7 cm small laparotomy was made 2 cm below the xiphoid process, the intra-abdominal adhesions were dissected as much as possible, and the duodenum was cut. The small laparotomy wound was sealed with a surgical glove and insufflated at 10 mmHg. Ports were placed 12 mm below the umbilicus, 12 mm 4 cm lateral to the umbilicus on each side, and 5 mm 2 cm below the rib arch on each side. The gastric tube was sharply dissected caudally up to the cervix using a laparoscopic mediastinal approach. Results We performed this technique in 5 patients. All cases were completed via a laparoscopic mediastinal approach without a median sternotomy. Compared to the laparoscopic-assisted approach, the use of pneumoperitoneum enlarged the retrosternal space, reduced bleeding, and provided a better operative field. Median mediastinal approach time was 151 minutes (range 135–184 minutes), median intraoperative blood loss was 220 g (range 140–370 g), and one patient had a postoperative right pyothorax, which improved with drainage. The median hospital stay was 18 days (range 14–21 days). Conclusion The laparoscopic mediastinal approach for patients with gastric tube cancer through a retrosternal route is a safe and minimally invasive approach that is superior in terms of improving the operative field and reducing bleeding due to insufflation pressure.