Experimental study of laparoscopic gastrectomy: intracorporeal Billroth I gastroduodenostomy.

Laparoscopic gastrectomy is now performed only for a partial resection that does not require anastomosis. We have been studying laparoscopic gastrectomy using the Billroth I method in animal models, and here we describe the surgical procedure. The gastrocolic ligament is divided along with the greater curvature, and the right gastroepiploic vessels are divided at their point of origin. The lesser omentum is dissected and the gastric antrum is divided using an endoscopic linear cutter. The anvil of a circular stapler is inserted into the duodenal bulb through the pyloric ring and ligated. An instrument for creating a pursestring suture is applied to the anterior wall of the stomach, and the circular stapler is inserted into the gastric lumen. Then Billroth I gastroduodenal anastomosis is performed with the stapler. After this anastomosis, four endoscopic linear cutters are applied to divide the gastric body, and the partial gastrectomy is completed. This animal experimental study has revealed that the Billroth I gastrectomy is easy to perform using a circular stapler and several linear cutters under laparoscopic guidance.