Commentary on “Totally Laparoscopic Total Gastrectomy Using Endoscopic Linear Stapler: Early Experiences at One Institute”

Kim et al. ¹ are to be commended on their report detailing their experience in performing laparoscopic total gastrectomy for treatment of gastric cancer. They do an excellent job of documenting the technical difficulties and the complications that occurred during the first 70 cases performed at their institution, and then they describe in detail the technical modifications they used that lowered intra- and postoperative complications.

The experiences these authors share with us could not have been completed at a U.S. medical center because they have reported experience with 124 patients with gastric cancer undergoing laparoscopic total gastrectomy at one institution in less than a year. That alone makes it very valuable to me because it would take a decade of experience at our institution to come close to the experience the authors report. This report also parallels the experience reported are similar in many respects to the issues surrounding minimally invasive esophagectomy. ² Despite the proven advantages to laparoscopic surgery for other diseases, the benefits of the laparoscopic/thoracoscopic approach for esophageal cancer remain controversial secondary to the technical difficulty and complications that arise especially early in the experience of the surgical team. This article is timely and useful for surgeons who want to consider offering a minimally invasive approach to total gastrectomy for gastric cancer. The description of the surgical procedure and the figures are extremely well done, and I would recommend them to the readership for review prior to attempting a laparoscopic gastric resection.