Clinical application of laparoscopic-assisted D2 radical surgery for progressive gastric cancer

  1.Laparoscopic-assisted progressive gastric cancer D2 radical resection of transverse colon mesenteric anterior lobe, the clearance of abdominal lymph nodes became a difficult point of the whole operation, and we made technical improvements in lymph node clearance. After the operator severed the adhesions with the transverse colon by ultrasonic knife, he used blunt pushing to separate the 2 branches of the middle colonic artery and the surface of the marginal artery from bottom to top and from right to left. In this way, while clearing the 15th group of lymph nodes, the anterior lobe of the colonic mesentery and the greater omentum can also be removed, and the anterior lobe of the transverse colonic mesentery can usually be peeled off to the level of the superior margin of the pancreas. Many scholars advocate that separation outside the vascular arch of the gastric omentum is prone to hemorrhage and incomplete lymph node dissection, which cannot reach the lymph node dissection range of standard radical surgery for gastric cancer (D2).  2. The lymph nodes of hepatoduodenal ligament are the second station lymph nodes of lymph node metastasis of gastric sinus cancer, and the lymph nodes and connective tissues in hepatoduodenal ligament can be cleared by pulling the three tubes separately under lumpectomy. There is no artificial touching and squeezing during the surgery, so that the surgery can better reflect the principle of tumor-free surgery.