Trocar placements for totally laparoscopic distal gastrectomy.

<p>Trocar placements for totally laparoscopic distal gastrectomy.</p

Risk factors influencing complications after TLDG with modified DSG for GC.

<p>TLDG totally laparoscopic distal gastrectomy; DSG delta-shaped gastroduodenostomy; GC gastric cancer; CI, confidence interval; NS, nutritional support; BPT, blood products transfusion; LN, lymph node.</p

The procedures of modified delta-shaped gastroduodenostomy before closing the common stab incision.

<p><b>a</b> Diagram showing that the stapler was positioned across the duodenum vertical to the long axis in the predetermined position and fired to transect the duodenum by rotating 90 degrees from back to front. <b>b</b> Intraoperative image showing that the stapler was positioned across the duodenum vertical to the long axis in the predetermined position and fired to transect the duodenum by rotating 90 degrees from back to front. <b>c</b> Diagram showing that the stomach was resected by successively transecting from the greater curvature to the lesser curvature with two staplers. <b>d</b> Intraoperative image showing that the stomach was resected by successively transecting from the greater curvature to the lesser curvature with two staplers. <b>e</b> Diagram showing that the stapler was positioned to join the posterior walls together. <b>f</b> Intraoperative image showing that the stapler was positioned to join the posterior walls together. <b>g</b> Diagram showing the V-shaped anastomosis on the posterior wall. <b>h</b> Intraoperative image showing the V-shaped anastomosis on the posterior wall.</p

Surgical outcomes of patients undergoing TLDG with modified DSG for GC.

<p>LN, lymph node. DSG, delta-shaped gastroduodenostomy. TLDG, totally laparoscopic distal gastrectomy. GC gastric cancer.</p

The differences between the conventional delta-shaped gastroduodenostomy (DSG) and the modified DSG.

<p><b>a</b> Diagram showing that three sutures were added to each end of the common stab incision and the cutting edges of the stomach and duodenum to obtain an involution and pull in the conventional DSG. <b>b</b> Diagram showing the completed involution of the common stab incision using the instruments of the surgeon and assistant with the blind angle of the duodenum being pulled up into the stapler in the modified DSG. <b>c</b> Diagram showing the completed conventional DSG with two intersections of the gastroduodenal cutting edge and the common closed edge. <b>d</b> Diagram showing the completed modified DSG with only one intersection of the gastric cutting edge and the common closed edge. <b>e</b> Intraoperative image showing the completed involution of the common stab incision using the instruments of the surgeon and assistant with the blind angle of the duodenum being pulled up into the stapler in the modified DSG. <b>f</b> Intraoperative image showing the completed inverted T-shaped appearance of anastomosis in the modified DSG.</p

The gastroscope image of one patient underwent the modified delta-shaped gastroduodenostomy on postoperative 3 months.

<p>The gastroscope image of one patient underwent the modified delta-shaped gastroduodenostomy on postoperative 3 months.</p

Clinicopathological Characteristics of patients undergoing TLDG with modified DSG for GC (n (%)).

<p>TLDG, totally laparoscopic distal gastrectomy; DSG, delta-shaped gastroduodenostomy; GC gastric cancer; BMI, body mass index; BPT, blood products transfusion; AJCC, American Joint Committee on Cancer 7th; pTNM, pathological tumor node metastasis.</p