PMC9889819_01
Steps of lymph node dissection. (A) Omentectomy toward the left gastroepiploic vessels. (B) Ligation and division of the left gastroepiploic vessels (RGEA, right gastroepiploic artery). (C) Division of the duodenum using a laparoscopic linear stapler. (D) Lymphadenectomy of lymph node station No. 8a (CHA, common hepatic artery; LN, lymph node). (E) Ligation and division of the left gastric artery (LGA, left gastric artery). (F) Division of the esophagus using a laparoscopic linear stapler.
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i) Partial omentectomy ( Figure 1A ) began with the division of the greater omentum more than 4 cm from the gastroepiploic arcade to include lymph node (LN) station No. 4d. The greater omentum was divided to mobilize the distal stomach. The right gastroepiploic vessels were ligated and divided to include LN station No. 6 ( Figure 1B ). As LN station No. 7 was dissected, the left gastric artery and coronary vein were ligated and divided ( Figure 1E ). Subsequently, the esophagus was divided using the Signia  Stapling System (Medtronic) ( Figure 1F ).
The reconstruction procedure. (A) Esophagojejunostomy using a laparoscopic linear stapler. (B) Closure of the common entry hole using a barbed suture material. (C) Jejunojejunostomy using a laparoscopic linear stapler. (D) Closure of the mesenteric defect due to jejunojejunostomy.
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To restore continuity of the digestive tract, an esophagojejunostomy was performed using the Signia  Stapling System (Medtronic) ( Figure 2A ). The common hole due to the stapled esophagojejunostomy was closed using a 3-0 absorbable barbed suture ( Figure 2B ). To connect the biliopancreatic limb to the digestive tract, a jejunojejunostomy was performed using the Signia  Stapling System (Medtronic) ( Figure 2C ). The jejunojejunostomy-associated mesenteric defect was closed using a 3-0 non-absorbable barbed suture ( Figure 2D ).
The postoperative wound. There was only one trans-umbilical wound in the abdomen.
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