To evaluate the safety and efficacy of reverse rolling-mat type lymph node dissection in hand-assisted laparoscopic surgery (HALS) of radical D2 gastrectomy.

The clinical data of one hundred and seventy patients with gastric cancer, who were treated in the Department of Gastrointestinal Surgery, Chengdu Military General Hospital between January 2013 and December 2014, were analyzed retrospectively. All patients were performed the reverse rolling-mat type technical approach for lymph node dissection, with the order of the lymph node dissection from Group 4sb, 10, 2, 11d, 11p, 7, 9, 8a, 1, 3 to Group 5 and 12a. After the stomach or esophagus was severed, the stomach and greater omentum were pulled out of the abdominal cavity, and the Group 6 lymph node was completely resected under direct visualization. The safety of the operation was evaluated on the basis of the average incision size, operation time, intraoperative blood loss, the number of lymph node dissected and length of hospital stay and perioperative complications after surgery.

93 cases underwent radical distal gastrectomy, 63 cases radical total gastrectomy, and 14 cases were given radical proximal gastrectomy. Mean incision length was (6.97±0.10) cm; operation time was (176.40±30.88) min; the number of dissected lymph node was (25.21±14.33); intraoperative bleeding level was (204.18 ±100.13) ml; postoperative hospital stay was (8.96±1.39) d. There was no death during operation. The incidence of postoperative complications was 4.12%.

The reverse rolling-mat type lymph node dissection has better radical efficacy of tumor resection and safety of operation, which might become a new procedure of hand-assisted laparoscopic surgery for gastric cancer surgery.