[Safety and feasibility of mobile double suspension technique in pure single-port laparoscopic D2 radical gastrectomy for distal gastric cancer].

Objective: To investigate the safety and feasibility of the mobile double suspension technique in pure single-port laparoscopic D2 radical gastrectomy for distal gastric cancer. Methods: The mobile double suspension technique involves percutaneously inserting an 18G syringe needle loaded with a 7# silk thread on each side of the xiphoid process to act as guidewires. Guided by these wires, a suspension clip is introduced on each side of the falciform ligament. During the procedure, effective visual field exposure and organ/tissue tension are achieved by suspending and retracting the greater omentum, gastric body, left lateral lobe of the liver, and the anastomotic site. Functionally, the dual-point suspension design effectively replaces the role of one surgical assistant. Results: From July 2022 to July 2024, the Department of Gastrointestinal Surgery at Yunnan Cancer Hospital of Kunming Medical University successfully performed pure single-port laparoscopic D2 radical distal gastrectomy assisted by the mobile double suspension technique in 17 patients. There were no conversions to open surgery or alterations in the surgical approach. The mean operative time was (207.2±50.6) minutes, intraoperative blood loss was (91.2±86.4) ml, and the number of lymph nodes retrieved was (36±14). Postoperative pain scores on days 1, 2, and 3 were (2.4±0.6), (1.8±0.6), and (1.2±0.4), respectively. Postoperative recovery indicators showed a time to first flatus of (2.9±0.3) days, time to first liquid intake of (1.5±0.7) days, drainage tube placement duration of (5.1±0.3) days, and postoperative hospital stay of (7.5±2.7) days. Two patients developed Clavien-Dindo grade III complications: one case of duodenal stump leakage and one case of anastomotic bleeding. Both complications were successfully managed with conservative treatment measures. Conclusions: The application of the mobile double suspension technique in pure single-port laparoscopic D2 radical distal gastrectomy can reduce the technical difficulty and shorten the operative time for single-port laparoscopic gastric cancer surgery, demonstrating its safety and feasibility.