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Mazzola et al. Mini-invasive Surg 2019;3:12 I http://dx.doi.org/10.20517/2574-1225.2019.05 Page 5 of 10

Figure 5. After specimen extraction, the mini-laparotomy on the left hemi-clavear trocar was used to place the circular stapler in the
previously sectioned jejunal loop and to reintroduce it in the peritoneal cavity restoring the pneumoperitoneum using a specialized
wound-sealing device

Figure 6. The end-to-side esophago-jejunal anastomosis was performed using 25 mm circular stapler and the jejunal loop extremity was
then sectioned using linear 45 mm stapler

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using a specialized wound-sealing device (GelPOINT Access Platforms, Applied Medical ) [Figure 5].
The E-S E-J anastomosis was performed using 25 mm circular stapler and the jejunal loop extremity was
then sectioned using linear 45 mm stapler [Figure 6]. In all the patients an external close suction drain
(type Jackson Pratt) was positioned via the right subcostal 5 mm port and positioned posteriorly to the E-J
anastomosis. All the patients resumed oral idric intake on 1st postoperative day and semi liquid diet on
2nd postoperative day, when tolerated. A ce-CT of thorax and abdomen with oral hydrosoluble contrast
examination was always performed on 6th postoperative day. After hospital discharge, follow-up was
continued in outpatient settings every six months.

RESULTS
Between January 2017 and June 2018 at our institution, 28 patients underwent surgery for middle-upper
third gastric cancer with curative intent; among these: 4 had previous gastric surgery for cancer and
received degastrogastrectomy, 4 underwent associated transhiatal distal esophagectomy, 1 underwent
upper polar gastrectomy. The remaining 19 underwent total gastrectomy; 9 of these received laparotomic
treatment because of anesthesiological contraindications to laparoscopy (2 patients), tumor involvement
of adjacent organs (4 patients), evidence of bulky nodes (1 patient), evidence of T4a tumor (1 patient),
or tumor located on the greater curvature (1 patient). 10 patients underwent totally laparoscopic total