Comparison of Single-Incision Laparoscopic Distal Gastrectomy and Laparoscopic Distal Gastrectomy for Gastric Cancer in a Porcine Model

Introduction: The single-incision laparoscopic approach may be suitable for several intra-abdominal surgical interventions, but its usefulness for treating gastric cancer has not been established. The aim of this study is to compare the perioperative outcomes of single-incision laparoscopic distal gastrectomy (SIDG) and conventional laparoscopic distal gastrectomy (LDG) by using a porcine model. Methods: Ten pigs were used to compare the perioperative outcomes of SIDG and LDG. All were subjected to the same distal gastrectomy with D1+beta lymph node dissection method. Specimens retrieved during the operation were subjected to manual lymph node picking and counting. To evaluate the inflammatory reactions, white blood cell (WBC) counts and C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor (TNF)-alpha levels were measured before and 1 hour, 1 day, and 5 days after surgery. The pigs were sacrificed 1 week after surgery. Results: The procedures were successfully performed in all pigs. The SIDG group lost more weight than the LDG group, but this was not statistically significant (3.34 +/- 2.36 kg versus 1.94 +/- 1.61 kg, P = .305). The SIDG group was associated with a significantly longer operation time (140 +/- 14.14 minutes versus 93 +/- 4.47 minutes, P < .001), but it had a similar mean number of resected lymph nodes (25 +/- 2.45 versus 22 +/- 4.87, P = .393). Variance analysis failed to detect significant WBC, CRP, IL-6, or TNF-alpha differences. At sacrifice, one pig from each group exhibited anastomosis narrowing. Conclusions: This animal study shows that SIDG can be applicable for treating gastric cancer with similar inflammatory reaction and complication rates when compared with LDG. Comparative human study is necessary to demonstrate the benefits of SIDG compared with standard laparoscopic surgery.