Application of the Seven-Step Method in Dual-Port Laparoscopic Radical Distal Gastrectomy for Gastric Cancer

Application of the Seven-Step Method in Dual-Port Laparoscopic Radical Distal Gastrectomy for Gastric Cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Application of the Seven-Step Method in Dual-Port Laparoscopic Radical Distal Gastrectomy for Gastric Cancer Wentao Zhang, Yuan Huo, Changfeng Miao, Xiong Li, Hongwei Tian This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7489791/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To explore the short-term efficacy and safety of the programmed seven-step method in dual-port laparoscopic radical distal gastrectomy for gastric cancer. Methods This retrospective study was conducted on patients with distal gastric cancer admitted to Gansu Provincial People's Hospital from January 2020 to January 2022. The seven-step method for dual-port laparoscopic radical distal gastrectomy was performed under strict inclusion and exclusion criteria. Postoperative short-term outcomes, including surgery-related and recovery-related-indicators, were analyzed. Results A total of 22 patients successfully underwent dual-port laparoscopic radical distal gastrectomy using the seven-step method. The overall complication rate was 18.18%; however, no surgery-related complications occurred, and there was no conversion to laparotomy or additional trocar insertions required during the procedure. A high level of satisfaction with postoperative wound aesthetics was reported by 81.82% of the patients. The mean number of dissected lymph node was 30.23 ± 4.99, the average operation time was 202.64 ± 27.03 min and the intraoperative blood loss was 82 ± 22.23 mL. The mean time to first ambulation was 38.59 ± 8.19 h, the time to first flatus was 50.36 ± 9.23 h, the average surgical incision length was 4.76 ± 0.63 cm and the average postoperative hospital stay was 8.86 ± 3.04 days. Conclusion The seven-step method for dual-port laparoscopic radical distal gastrectomy is safe and feasible, offering minimal postoperative pain, favorable cosmetic outcomes and rapid recovery. Stomach neoplasms Programmed seven-step method Dual-port laparoscopic Distal gastrectomy Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Gastric cancer is one of the leading causes of cancer-related deaths worldwide. Over the past few decades, the incidence and mortality rates of gastric cancer have been declining in Western countries, whereas in other regions, they have either increased or remained stable [ 1 ]. According to 2015 cancer statistics in China, gastric cancer ranked second in both incidence and mortality rates among malignant tumors [ 2 ]. Currently, the primary treatment for gastric cancer is surgery, supplemented by perioperative adjuvant therapies. From the successful implementation of single-port laparoscopic distal gastrectomy from 2011–2015 [ 3 – 5 ] to the smooth completion of single-port laparoscopic proximal gastrectomy in 2016 [ 6 ], single-port laparoscopic techniques have rapidly developed. Nevertheless, due to the "coaxial effect" [ 7 ] associated with single-port laparoscopic surgery (SILS), instrument interference remains a significant challenge. Compared to the conventional five-port laparoscopic approach, single-port surgery is associated with limited surgical field exposure and increased technical difficulty [ 8 ], hindering its widespread and rational application at this stage. However, the emergence of dual-port laparoscopic radical distal gastrectomy (DPLRDG) has effectively addressed these limitations. DPLRDG builds on the single-port approach by creating an independent main operating port and incorporating appropriate laparoscopic suspension techniques. This modification significantly improves surgical field exposure, minimizes interference between the surgeon and the scope assistant, and simplifies the surgical workflow, while maintaining the advantages of minimally invasive surgery. Additionally, the placement of a drainage tube through the main operating port ensures adequate drainage without compromising the minimally invasive benefits, thereby enhancing procedural safety. From a clinical perspective, DPLRDG allows for specimen retrieval through a transumbilical or periumbilical incision, preserving abdominal wall integrity, reducing postoperative pain and minimizing the impact on gastrointestinal function. This approach facilitates rapid recovery, ultimately reducing patient trauma and discomfort [ 9 ]. The procedural standardization of surgical steps divides the operation into multiple phases, which are executed sequentially according to a predefined plan. The close collaboration of the surgical assistant and the consistent field of view and angles provided by the scope assistant achieve seamless integration among all three components. Furthermore, the proceduralized approach systematically segments lymph node dissection into distinct parts, aiding the surgeon in maintaining a smooth surgical workflow while ensuring more thorough lymph node clearance, thereby enhancing surgical safety [ 10 ]. At our General Surgery Clinical Center, we have developed a standardized seven-step protocol for laparoscopic or robot-assisted distal gastrectomy for gastric cancer. To evaluate its short-term efficacy, we analyzed patients with distal gastric cancer who underwent DPLRDG at the General Surgery Center of Gansu Provincial Hospital between January 2020 and January 2022. Methods Patients Inclusion criteria 1) BMI < 25 kg/m 2 ; 2) Tumor located in the gastric antrum or body, with adenocarcinoma confirmed by endoscopic biopsy; 3) No history of upper abdominal surgery; 4) Staging assessed as cT 1b – 3 N 0 – 1 M 0 according to the 8th edition of the AJCC Cancer Staging Manual, based on preoperative endoscopic ultrasonography, abdominal CT or MRI; 5) Patient age between 18 and 75 years; 6) Preoperative ASA (American Society of Anesthesiologists) score of I–II; and 7) Patients provided informed consent and voluntarily chose to undergo dual-port laparoscopic surgery. Exclusion criteria 1) Emergency surgery due to complications associated with gastric cancer; 2) Eligibility for endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR); 3) Previous upper abdominal surgery; 4) Intraoperative findings of distant metastases; 5) Prior radiotherapy or chemotherapy; 6) Requirement for simultaneous surgery for other diseases; 7) Pregnancy or lactation; and 8) Severe dysfunction of the heart, lungs, brain, liver or kidneys, rendering the patient unable to tolerate surgery. From January 2020 to January 2022, gastric cancer patients at the General Surgery Clinical Center of Gansu Provincial Hospital were screened according to the aforementioned inclusion and exclusion criteria. A total of 22 patients were enrolled to undergo DPLRDG. All procedures were performed by the same surgical team, led by a primary surgeon with extensive experience in laparoscopic radical gastrectomy. All patients voluntarily opted for dual-port laparoscopic surgery and provided written informed consent prior to undertaking the procedure. Surgical method Preoperative preparation After successful induction of general anesthesia, the patient was placed in a split-leg position. The surgeon stood on the patient's left side, the scope assistant between the patient’s legs and the surgical assistant on the patient’s right side, as illustrated in Fig. 1 . A 2.5–3 cm incision was made below the umbilicus to insert a single-port multi-channel surgical device and establish pneumoperitoneum at a pressure of 12 mmHg. Additionally, a 1.2 cm trocar was placed along the midclavicular line below the left costal margin, serving as the primary operating port and the postoperative drainage site (Fig. 2 ) . The liver was suspended to facilitate adequate visualization. The proceduralized seven-step surgical technique is detailed in reference [ 11 ] and shown in Figs. 3 and 4 . (a: Incision, suspension, and exploration; b: Right side of the greater curvature and the region below the pylorus (4d, 6); c: The area above the pylorus, transection of the duodenum and clearance of the hepatoduodenal ligament (5, 12a); d: Clearance of the area anterior to the pancreas (7, 8a, 9, 11p); e: Clearance of the lesser curvature area (1, 3); f: Clearance of the left greater curvature area (4sb); g: Transaction of the gastric specimen and Billroth II anastomosis.) Observation indicators Surgical indicators Intraoperative blood loss, operative time, laparotomy conversion rate, additional trocar count and the number of dissected lymph nodes. Postoperative recovery indicators Time to first ambulation, time to first flatus, time to first intake of liquid diet, total postoperative hospital stay, time to removal of abdominal drainage tube, pain scores on postoperative days 1, 3 and 5, and complications within 30 days post-surgery. Pain scores were assessed using the Visual Analog Scale (VAS). Complications were classified according to the Clavien-Dindo grading system [ 12 ]. Patient satisfaction with wound cosmesis was evaluated using the Cosmetic Scale (CS) [ 13 ], which ranges from 3 to 24 points. Higher scores indicate greater satisfaction with the cosmetic appearance of the incision. Satisfaction levels were categorized as low (3–9 points), moderate (10–17 points) and high (18–24 points). Statistical methods Data were analyzed using SPSS ver. 25.0. Continuous variables are expressed as the mean ± standard deviation (x̅ ± s) and were compared using the independent samples t -test, assuming a normal distribution and homogeneity of variance. Non-normally distributed data are presented as median values. Categorical variables are summarized as frequencies and percentages. A significance level of α = 0.05 was used. Results This study included 22 patients, whose baseline characteristics are summarized in Table 1 . All patients successfully underwent distal gastrectomy with radical resection for gastric cancer using the dual-port laparoscopic seven-step method. Billroth II anastomosis was used for digestive tract reconstruction in all cases. During surgery, a urinary catheter and a single abdominal drainage tube were routinely placed, while nasogastric and enteral nutrition tubes were not routinely utilized. Intraoperative details are given in Table 2 . Table 1 Baseline characteristics of patients Variable Patients (n = 22) Age (years, \(\:\stackrel{-}{x}\:\pm\:\:s\) ) 55.32 ± 10.42 Gender (n, %) Male 17 (77.27%) Female 5 (22.72%) BMI (kg/m 2 , \(\:\stackrel{-}{x}\:\pm\:\:s\) ) 20.73 ± 2.58 Tumor TNM stage (n, %) 0 0 Ⅰ 7 (31.82%) Ⅱ 13 (59.09%) Ⅲ 2 (9.09%) Table 2 Intraoperative data analysis of patients Variable Patients (n = 22) Operative time (min, \(\:\stackrel{-}{x}\:\pm\:\:s\) ) 202.64 ± 27.03 Intraoperative blood loss (mL, \(\:\stackrel{-}{x}\:\pm\:\:s\) ) 82 ± 22.23 Conversion to laparotomy (n, %) 0 Additional trocar placement (n, %) 0 Maximum tumor diameter (cm, \(\:\stackrel{-}{x}\:\pm\:\:s\) ) 3.67 ± 1.20 Number of dissected lymph nodes (n, \(\:\stackrel{-}{x}\:\pm\:\:s\) ) 30.23 ± 4.99 Incision length (cm, \(\:\stackrel{-}{x}\:\pm\:\:s\) ) 4.76 ± 0.63 On the first postoperative day, patients were encouraged to mobilize early based on their individual conditions, with urinary catheters removed promptly. Small amounts of water were permitted to be imbibed and routine intravenous nutritional support was provided. Postoperative management included Zusanli (ST36) acupuncture point massage, rectal administration of glycerin enemas and other interventions to facilitate bowel function recovery and spontaneous flatus. Patients were transitioned to clear fluids and small amounts of a liquid diet as soon as possible. The abdominal drainage tube was removed once the daily drainage volume was less than 100 mL for two consecutive days. Postoperative outcomes are summarized in Table 3 . Table 3 Postoperative recovery outcomes Indicator Patients (n = 22) Time to first flatus (h, \(\:\stackrel{-}{x}\:\pm\:\:s\) ) 50.36 ± 9.23 Time to first ambulation (h, \(\:\stackrel{-}{x}\:\pm\:\:s\) ) 38.59 ± 8.19 Time to first liquid diet (h, \(\:\stackrel{-}{x}\:\pm\:\:s\) ) 67.95 ± 11.19 Postoperative hospital stay (d, \(\:\stackrel{-}{x}\:\pm\:\:s\) ) 8.86 ± 3.04 Time to drain removal (d, \(\:\stackrel{-}{x}\:\pm\:\:s\) ) 8.68 ± 1.76 Pain scores (point, \(\:\stackrel{-}{x}\:\pm\:\:s\) ) 12 h 4.45 ± 0.96 24 h 3.41 ± 0.91 48 h 2.68 ± 0.78 72 h 1.55 ± 0.59 Postoperative complications within 30 days (n, %) 4 (18.18%) Types of complications (n, %) Hypoproteinemia 2 (9.09%) Pleural effusion 1 (4.55%) Wound infection 1 (4.55%) Deep vein thrombosis 1 (4.55%) Clavien-Dindo Classification (n, %) Ⅰ 1 (4.55%) Ⅱ 2 (9.1%) Ⅲ 1 (4.55%) Wound healing score (CS score, n, %) High 18 (81.82%) Medium 3 (13.64%) Low 1 (4.55%) Tumor TNM stage (n, %) Ⅰ 4 (18.18%) Ⅱ 15 (68.18%) Ⅲ 3 (13.64%) Discussion D2 radical gastrectomy for gastric cancer involves an extensive surgical field and complex lymphadenectomy, posing significant technical challenges for surgeons. It demands not only proficient laparoscopic surgical skills but also a thorough understanding of the anatomical structures under laparoscopy [ 14 ]. Furthermore, laparoscopic surgery eliminates tactile feedback, limits the surgical field of view due to insufficient retractor exposure and confines operations within a narrow and restricted visual space, factors which make gastric mobilization and lymph node dissection more challenging than traditional laparotomy. Therefore, close collaboration among the surgeon, first assistant and scope assistant is essential [ 15 ]. Since early 2017, our surgical team has developed and refined a "Seven-Step" procedural approach for laparoscopic D2 radical gastrectomy, introducing a structured and standardized concept [ 10 ]. This method segments lymphadenectomy into a series of orderly steps, which helps the surgeon maintain a clear operative strategy and ensures more thorough lymph node dissection, ultimately enhancing surgical safety [ 9 ]. Proceduralized surgery encompasses both the systematic organization of surgical steps and the coordinated efforts of the surgical team [ 16 ]. By adhering to this systematic approach, the surgeon and assistants remain aligned in their strategies and actions throughout the procedure. This standardized surgical model offers multiple advantages. It minimizes intraoperative manipulation and clamping of the remnant stomach and intestines, thereby promoting postoperative gastrointestinal recovery [ 17 ]. Additionally, improved exposure and team coordination shorten operation times, prevent damage to adjacent organs, reduce the incidence of postoperative complications and accelerate patient recovery [ 18 , 19 ]. The implementation of standardized and structured procedures simplifies the surgical process, ensures clear and organized anatomical exposure, reduces surgical complexity and improves operational efficiency. Furthermore, this approach facilitates learning and dissemination in primary healthcare settings, promoting the adoption of advanced surgical techniques, optimizing the allocation of medical resources and enabling broader clinical applications. Since Kitano first introduced laparoscopic techniques for the treatment of gastric cancer, this approach has garnered widespread attention and led to significant advances [ 20 – 22 ]. With the growing adoption of Enhanced Recovery After Surgery (ERAS) principles and an increasing demand for minimally invasive procedures, SILS has rapidly developed due to its minimally invasive advantages. However, SILS faces technical challenges, including the "chopstick effect," "coaxial effect," and difficulties in digestive tract reconstruction, which limit its broader application. To address these limitations, the dual-port laparoscopic technique has emerged as an effective alternative. By isolating the primary operating port, the dual-port approach minimizes instrument interference, enabling smoother surgical maneuvers and providing improved access for digestive tract reconstruction. Additionally, the independent drainage port eliminates the need for extra incisions, thereby reducing the postoperative burden on patients. Lymph node dissection remains a critical focus in radical gastrectomy for gastric cancer. Compared to the conventional five-port laparoscopic approach, this study reduces the number of trocar ports without compromising the use of surgical instruments. The procedure's success relies on seamless collaboration between the assistant and the lead surgeon. By implementing a standardized and streamlined surgical protocol, each region's exposure and dissection were performed in a systematic and efficient manner. Furthermore, the independent placement of the primary operating port below the left costal margin provided greater maneuverability, enhancing operational precision and flexibility. The dual-port approach, combined with the seven-step method for laparoscopic radical gastrectomy, optimized the surgical pathway and refined the sequence of lymph node dissection, significantly reducing the complexity of the procedure. The number of dissected lymph nodes in this study (30.23 ± 4.99) was comparable to that achieved using the five-port seven-step robot-assisted radical gastrectomy technique (30.3 ± 2.5) [ 10 ]. However, the limited sample size and lack of a control group in the present study necessitates further research and validation to confirm and expand upon the findings. The core principle of ERAS is to optimize perioperative management through multidisciplinary collaboration and evidence-based practices, aiming to facilitate rapid recovery, early discharge and a reduction in postoperative complications [ 23 ]. Postoperative pain is one of the primary stressors for patients [ 24 ]. The DPLRDG offers advantages such as smaller incisions and fewer wounds. Additionally, routine local anesthetic blockade around the wound at the end of the surgery significantly alleviates postoperative pain. This approach enables patients to ambulate earlier, promotes gastrointestinal function recovery and aligns well with the principles of ERAS. Postoperative complications are key indicators for evaluating surgical outcomes and recovery. The present study included 22 patients, among whom 1 developed a small amount of pleural effusion after surgery, which resolved after oral diuretic treatment. Another patient experienced both hypoproteinemia and wound infection, treated successfully with albumin supplementation and wound care. One patient had hypoproteinemia alone and recovered after receiving human albumin supplementation. Additionally, 1 patient developed deep vein thrombosis (DVT), which was managed with the placement of an inferior vena cava filter. The occurrence of DVT may be attributed to the patient’s long-standing history of hypertension and diabetes, along with limited daily activity after first ambulating 53 h postoperatively. Importantly, no surgery-related complications such as anastomotic leakage or intra-abdominal bleeding were observed in the 22 patients. The overall complication rate was 18.18%, consistent with previously reported rates of complications in reduced-port laparoscopic radical gastrectomy for gastric cancer (4.1–42.9%) [ 25 – 27 ]. Wound aesthetics are a significant advantage of the dual-port laparoscopic surgery. Compared to the conventional five-port approach, the dual-port method reduces the number of incisions and employs subcutaneous cosmetic suturing, thereby minimizing the risk of prominent scar formation. Among the 22 patients in the present study, 18 reported high satisfaction with their postoperative wounds. One patient experienced subcutaneous fat liquefaction, requiring daily wound dressing for one week. Although the wound eventually healed, this patient reported lower satisfaction. In summary, the dual-port laparoscopic approach, combined with the seven-step method is a viable option for radical distal gastrectomy. Preliminary studies suggest that its short-term efficacy and safety are comparable to those of the conventional five-port approach. Moreover, the reduced-port technique promotes faster recovery, less postoperative pain, and higher patient satisfaction with wound outcomes, aligning with ERAS principles. However, this study's small sample size and single-center design necessitate further multicenter, large-scale studies to validate its long-term efficacy and safety. Conclusion The seven-step method for dual-port laparoscopic radical distal gastrectomy is safe and feasible, offering minimal postoperative pain, favorable cosmetic outcomes and rapid recovery. Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of the Gansu Provincial Hospital (approval number: 2024-319, date: March 16, 2024). All patients voluntarily opted for dual-port laparoscopic surgery and provided written informed consent prior to undertaking the procedure. All methods were carried out in accordance with Declaration of Helsinki. Consent for publication Not applicable. Availability of data and materials All data, materials and methods in this study can be made available from the corresponding author upon request for non-commercial purposes and after approval of study proposal through a signed data access agreement. Competing Interests The authors declare no competing interests. Funding This work was supported: Lanzhou Science and Technology Research and Development Program (2023-ZD-19); Author contributions Wentao Zhang and Hongwei Tian were involved in the conception and design; Xiong Li, Yuan Huo, Changfeng Miao were involved in the analysis and interpretation of data; Wentao Zhang, Yuan Huo, Changfeng Miao were involved in the drafting of the paper or revising; Wentao Zhang and Hongwei Tian were involved the Information Classification: General final approval of the version to be published; and that all authors agree to be accountable for all aspects of the work. References Giuliani A, Miccini M, Basso L. Extent of lymphadenectomy and perioperative therapies: two open issues in gastric cancer. World J Gastroenterol. 2014;20:3889–904. Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, et al. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66:115–32. Kim SM, Lee SH, Ha MH, Seo JE, Kim JE, Choi MG, et al. Techniques of the Single-Port Totally Laparoscopic Distal Gastrectomy. Ann Surg Oncol. 2015;22(Suppl 3):S341. Kong J, Wu SD, Su Y. Translumenal single-incision laparoscopy radical gastrectomy with D2 lymph node dissection for early gastric cancer–primary experience with less invasive surgery in China. J Laparoendosc Adv Surg Tech A. 2013;23:141–5. Park DJ, Lee JH, Ahn SH, Eng AK, Kim HH. Single-port laparoscopic distal gastrectomy with D1 + β lymph node dissection for gastric cancers: report of 2 cases. Surg Laparosc Endosc Percutan Tech. 2012;22:e214–6. Lee CM, Park DW, Jung DH, Jang YJ, Kim JH, Park S, et al. Single-Port Laparoscopic Proximal Gastrectomy with Double Tract Reconstruction for Early Gastric Cancer: Report of a Case. J Gastric Cancer. 2016;16:200–6. Professional committee of. single incision laparoscopic surgery, minimally invasive medicine committee of chinese medical doctor association. Expert consensus on single incision plus one laparoscopic gastric cancer surgery (2020 version). J Laparosc Surg. 2021;26:7–12. Yan S, Ma XF, Zhao K, Chen XQ, Guo C, Wang QQ, et al. Analysis of technical difficulties of single-port and reduced port laparoscopic radical gastrectomy for gastric cancer. Chin J Dig Surg. 2019;18:222–8. Lin T, Yu J, Hu YF, Liu H, Lu YM, Zhao ML, et al. Preliminary experience of dual port laparoscopic distal gastrectomy for gastric cancer. Chin J Gastrointest Surg. 2019;22:35–42. Park EJ, Kim CW, Cho MS, Kim DW, Min BS, Baik SH, et al. Is the learning curve of robotic low anterior resection shorter than laparoscopic low anterior resection for rectal cancer? a comparative analysis of clinicopathologic outcomes between robotic and laparoscopic surgeries. Med (Baltim). 2014;93:e109. Huang XB, Hu M, Cai H, Zhan WP, Yang J, Ma YT. Programmedseven-step methodin distal radical gastrectomy with Da Vinci robot3 + 2mode. Chin J Clin Oncol. 2022;49:124–8. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13. Dunker MS, Stiggelbout AM, van Hogezand RA, Ringers J, Griffioen G, Bemelman WA. Cosmesis and body image after laparoscopic-assisted and open ileocolic resection for Crohn's disease. Surg Endosc. 1998;12:1334–40. Kunisaki C, Makino H, Yamamoto N, Sato T, Oshima T, Nagano Y, et al. Learning curve for laparoscopy-assisted distal gastrectomy with regional lymph node dissection for early gastric cancer. Surg Laparosc Endosc Percutan Tech. 2008;18:236–41. Goitein D, Mintz Y, Gross D, Reissman P. Laparoscopic adrenalectomy: ascending the learning curve. Surg Endosc. 2004;18:771–3. Tang LM, Qian J. The procedures and modeling of laparoscopic D2 radical gastrectomy in gastric cancer. Chin J Laparosc Surg (Electronic Edition). 2010;3:306–8. Li GL, Lin Q, Zheng SY, Zhou QB, Chen RF. The evaluation of laparoscopic pancreaticoduodenectomy with programmed process. Chin J Laparosc Surg (Electronic Edition). 2018;11:85–9. Zhu CH, Huang CQ, Huang HW, Gao SQ, Xu JB, Cai ZR. Clinical application research of anatomical and programmed retroperitoneoscopic adrenalectomy by six-step procedure. China J Endoscopy. 2020;26:72–7. Yang YF, Wang WK, Zhao QX, Song LM, Xing NZ. Programmed laparoscopic radical cystectomy for bladder cancer: clinical experience summary of 120 cases. J Clin Urol. 2018;33:859–64. Cai M, Zeng XY, Xiong Z, Gao JB, Shuai XM, Cai KL, et al. Early postoperative complications and risk factors in laparoscopic D2 radical gastrectomy for gastric cancer. Chin J Gastrointest Surg. 2019;22:742–7. Wang Q, Feng DB, He J, Wang XN, Zhang YF, Zhang J, et al. Comparison of the application effect of single incision + 1 port and conventional laparoscopic surgery in radical gastrectomy for gastric cancer. Clin Res Pract. 2020;5:9–103. Kitano S, Tomikawa M, Iso Y, Hashizume M, Moriyama M, Sugimachi K. Laparoscopy-assisted devascularization of the lower esophagus and upper stomach in the management of gastric varices. Endoscopy. 1994;26:470–3. Expert consensus on robotic surgery in gastric cancer. (2015 edition) Editorial committee. Expert consensus on robotic surgery in gastric cancer (2015 edition). Journal of Chinese Research Hospitals. 2016;3:22 – 8. Eom BW, Yoon HM, Ryu KW, Lee JH, Cho SJ, Lee JY, et al. Comparison of surgical performance and short-term clinical outcomes between laparoscopic and robotic surgery in distal gastric cancer. Eur J Surg Oncol. 2012;38:57–63. Omori T, Fujiwara Y, Moon J, Sugimura K, Miyata H, Masuzawa T, et al. Comparison of Single-Incision and Conventional Multi-Port Laparoscopic Distal Gastrectomy with D2 Lymph Node Dissection for Gastric Cancer: A Propensity Score-Matched Analysis. Ann Surg Oncol. 2016;23:817–24. Kim SM, Ha MH, Seo JE, Kim JE, Choi MG, Sohn TS, et al. Comparison of single-port and reduced-port totally laparoscopic distal gastrectomy for patients with early gastric cancer. Surg Endosc. 2016;30:3950–7. Kim HG, Kim DY, Jeong O. Transition from Conventional to Reduced-Port Laparoscopic Gastrectomy to Treat Gastric Carcinoma: a Single Surgeon's Experience from a Small-Volume Center. J Gastric Cancer. 2018;18:172–81. Additional Declarations No competing interests reported. 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02:20:24","extension":"xml","order_by":18,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":80184,"visible":true,"origin":"","legend":"","description":"","filename":"3742307c9a2041f2bf720d0510acb3ec1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7489791/v1/21b5c910807fa586b895e4b0.xml"},{"id":93730380,"identity":"dc281568-1b9d-499f-9bab-5ae4c1457804","added_by":"auto","created_at":"2025-10-17 02:20:24","extension":"html","order_by":19,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":87535,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7489791/v1/f7dc739f3407f0625cf11f0d.html"},{"id":93730371,"identity":"5cc4dc06-2e40-46a5-8c56-37da0faba25b","added_by":"auto","created_at":"2025-10-17 02:20:23","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":90362,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic of surgical positioning.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7489791/v1/f8d35d7ae5c9235efcde5b09.png"},{"id":93730367,"identity":"054e2c9d-6485-4b43-9de3-f4aee720b03a","added_by":"auto","created_at":"2025-10-17 02:20:23","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":358391,"visible":true,"origin":"","legend":"\u003cp\u003eTrocar layout and postoperative wound.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7489791/v1/18ac1add047d88d874087a1b.png"},{"id":93730373,"identity":"c1af889d-d716-4cd8-8c10-bd2fae43e475","added_by":"auto","created_at":"2025-10-17 02:20:24","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1242025,"visible":true,"origin":"","legend":"\u003cp\u003eThe seven-step surgical procedure. a: Incision, suspension, and exploration; b: Right side of the greater curvature and the region below the pylorus (4d, 6); c: The area above the pylorus, transection of the duodenum and clearance of the hepatoduodenal ligament (5, 12a); d: Clearance of the area anterior to the pancreas (7, 8a, 9, 11p); e: Clearance of the lesser curvature area (1, 3); f: Clearance of the left greater curvature area (4sb); g: Transaction of the gastric specimen and Billroth II anastomosis.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-7489791/v1/510c36cb562d6e5d3714cb4c.png"},{"id":93730391,"identity":"45467075-63d1-4606-ae57-7a3ef317ddd1","added_by":"auto","created_at":"2025-10-17 02:20:24","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":756280,"visible":true,"origin":"","legend":"\u003cp\u003eThe seven-step surgical technique and pathway.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-7489791/v1/bf43fe2a9718fe3796035dc6.png"},{"id":93900374,"identity":"eb9130ff-74e3-4f85-a23d-0ac869ed8702","added_by":"auto","created_at":"2025-10-20 05:08:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3663635,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7489791/v1/4721ca44-a938-48d5-a25d-77a02fcb3f13.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Application of the Seven-Step Method in Dual-Port Laparoscopic Radical Distal Gastrectomy for Gastric Cancer","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGastric cancer is one of the leading causes of cancer-related deaths worldwide. Over the past few decades, the incidence and mortality rates of gastric cancer have been declining in Western countries, whereas in other regions, they have either increased or remained stable [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. According to 2015 cancer statistics in China, gastric cancer ranked second in both incidence and mortality rates among malignant tumors [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Currently, the primary treatment for gastric cancer is surgery, supplemented by perioperative adjuvant therapies. From the successful implementation of single-port laparoscopic distal gastrectomy from 2011\u0026ndash;2015 [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] to the smooth completion of single-port laparoscopic proximal gastrectomy in 2016 [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], single-port laparoscopic techniques have rapidly developed.\u003c/p\u003e\u003cp\u003eNevertheless, due to the \"coaxial effect\" [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] associated with single-port laparoscopic surgery (SILS), instrument interference remains a significant challenge. Compared to the conventional five-port laparoscopic approach, single-port surgery is associated with limited surgical field exposure and increased technical difficulty [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], hindering its widespread and rational application at this stage. However, the emergence of dual-port laparoscopic radical distal gastrectomy (DPLRDG) has effectively addressed these limitations. DPLRDG builds on the single-port approach by creating an independent main operating port and incorporating appropriate laparoscopic suspension techniques. This modification significantly improves surgical field exposure, minimizes interference between the surgeon and the scope assistant, and simplifies the surgical workflow, while maintaining the advantages of minimally invasive surgery. Additionally, the placement of a drainage tube through the main operating port ensures adequate drainage without compromising the minimally invasive benefits, thereby enhancing procedural safety. From a clinical perspective, DPLRDG allows for specimen retrieval through a transumbilical or periumbilical incision, preserving abdominal wall integrity, reducing postoperative pain and minimizing the impact on gastrointestinal function. This approach facilitates rapid recovery, ultimately reducing patient trauma and discomfort [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe procedural standardization of surgical steps divides the operation into multiple phases, which are executed sequentially according to a predefined plan. The close collaboration of the surgical assistant and the consistent field of view and angles provided by the scope assistant achieve seamless integration among all three components. Furthermore, the proceduralized approach systematically segments lymph node dissection into distinct parts, aiding the surgeon in maintaining a smooth surgical workflow while ensuring more thorough lymph node clearance, thereby enhancing surgical safety [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. At our General Surgery Clinical Center, we have developed a standardized seven-step protocol for laparoscopic or robot-assisted distal gastrectomy for gastric cancer. To evaluate its short-term efficacy, we analyzed patients with distal gastric cancer who underwent DPLRDG at the General Surgery Center of Gansu Provincial Hospital between January 2020 and January 2022.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePatients\u003c/h2\u003e\u003cp\u003e\u003cem\u003eInclusion criteria\u003c/em\u003e\u003c/p\u003e\u003cp\u003e1) BMI\u0026thinsp;\u0026lt;\u0026thinsp;25 kg/m\u003csup\u003e2\u003c/sup\u003e; 2) Tumor located in the gastric antrum or body, with adenocarcinoma confirmed by endoscopic biopsy; 3) No history of upper abdominal surgery; 4) Staging assessed as cT\u003csub\u003e1b\u003c/sub\u003e\u0026ndash;\u003csub\u003e3\u003c/sub\u003eN\u003csub\u003e0\u003c/sub\u003e\u0026ndash;\u003csub\u003e1\u003c/sub\u003eM\u003csub\u003e0\u003c/sub\u003e according to the 8th edition of the AJCC Cancer Staging Manual, based on preoperative endoscopic ultrasonography, abdominal CT or MRI; 5) Patient age between 18 and 75 years; 6) Preoperative ASA (American Society of Anesthesiologists) score of I\u0026ndash;II; and 7) Patients provided informed consent and voluntarily chose to undergo dual-port laparoscopic surgery.\u003c/p\u003e\u003cp\u003e\u003cem\u003eExclusion criteria\u003c/em\u003e\u003c/p\u003e\u003cp\u003e1) Emergency surgery due to complications associated with gastric cancer; 2) Eligibility for endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR); 3) Previous upper abdominal surgery; 4) Intraoperative findings of distant metastases; 5) Prior radiotherapy or chemotherapy; 6) Requirement for simultaneous surgery for other diseases; 7) Pregnancy or lactation; and 8) Severe dysfunction of the heart, lungs, brain, liver or kidneys, rendering the patient unable to tolerate surgery.\u003c/p\u003e\u003cp\u003e From January 2020 to January 2022, gastric cancer patients at the General Surgery Clinical Center of Gansu Provincial Hospital were screened according to the aforementioned inclusion and exclusion criteria. A total of 22 patients were enrolled to undergo DPLRDG. All procedures were performed by the same surgical team, led by a primary surgeon with extensive experience in laparoscopic radical gastrectomy. All patients voluntarily opted for dual-port laparoscopic surgery and provided written informed consent prior to undertaking the procedure.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSurgical method\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003ePreoperative preparation\u003c/h2\u003e\u003cp\u003eAfter successful induction of general anesthesia, the patient was placed in a split-leg position. The surgeon stood on the patient's left side, the scope assistant between the patient\u0026rsquo;s legs and the surgical assistant on the patient\u0026rsquo;s right side, as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. A 2.5\u0026ndash;3 cm incision was made below the umbilicus to insert a single-port multi-channel surgical device and establish pneumoperitoneum at a pressure of 12 mmHg. Additionally, a 1.2 cm trocar was placed along the midclavicular line below the left costal margin, serving as the primary operating port and the postoperative drainage site (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. The liver was suspended to facilitate adequate visualization.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe proceduralized seven-step surgical technique is detailed in reference [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and shown in Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e(a: Incision, suspension, and exploration; b: Right side of the greater curvature and the region below the pylorus (4d, 6); c: The area above the pylorus, transection of the duodenum and clearance of the hepatoduodenal ligament (5, 12a); d: Clearance of the area anterior to the pancreas (7, 8a, 9, 11p); e: Clearance of the lesser curvature area (1, 3); f: Clearance of the left greater curvature area (4sb); g: Transaction of the gastric specimen and Billroth II anastomosis.)\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eObservation indicators\u003c/h3\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eSurgical indicators\u003c/h2\u003e\u003cp\u003eIntraoperative blood loss, operative time, laparotomy conversion rate, additional trocar count and the number of dissected lymph nodes.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003ePostoperative recovery indicators\u003c/h2\u003e\u003cp\u003eTime to first ambulation, time to first flatus, time to first intake of liquid diet, total postoperative hospital stay, time to removal of abdominal drainage tube, pain scores on postoperative days 1, 3 and 5, and complications within 30 days post-surgery. Pain scores were assessed using the Visual Analog Scale (VAS). Complications were classified according to the Clavien-Dindo grading system [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Patient satisfaction with wound cosmesis was evaluated using the Cosmetic Scale (CS) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], which ranges from 3 to 24 points. Higher scores indicate greater satisfaction with the cosmetic appearance of the incision. Satisfaction levels were categorized as low (3\u0026ndash;9 points), moderate (10\u0026ndash;17 points) and high (18\u0026ndash;24 points).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStatistical methods\u003c/h3\u003e\n\u003cp\u003eData were analyzed using SPSS ver. 25.0. Continuous variables are expressed as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x̅ \u0026plusmn; s) and were compared using the independent samples \u003cem\u003et\u003c/em\u003e-test, assuming a normal distribution and homogeneity of variance. Non-normally distributed data are presented as median values. Categorical variables are summarized as frequencies and percentages. A significance level of α\u0026thinsp;=\u0026thinsp;0.05 was used.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThis study included 22 patients, whose baseline characteristics are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. All patients successfully underwent distal gastrectomy with radical resection for gastric cancer using the dual-port laparoscopic seven-step method. Billroth II anastomosis was used for digestive tract reconstruction in all cases. During surgery, a urinary catheter and a single abdominal drainage tube were routinely placed, while nasogastric and enteral nutrition tubes were not routinely utilized. Intraoperative details are given in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline characteristics of patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePatients (n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\:\\pm\\:\\:s\\)\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55.32\u0026thinsp;\u0026plusmn;\u0026thinsp;10.42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (77.27%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (22.72%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\:\\pm\\:\\:s\\)\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20.73\u0026thinsp;\u0026plusmn;\u0026thinsp;2.58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTumor TNM stage (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eⅠ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (31.82%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eⅡ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (59.09%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eⅢ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (9.09%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eIntraoperative data analysis of patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePatients (n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOperative time (min, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\:\\pm\\:\\:s\\)\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e202.64\u0026thinsp;\u0026plusmn;\u0026thinsp;27.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntraoperative blood loss (mL, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\:\\pm\\:\\:s\\)\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82\u0026thinsp;\u0026plusmn;\u0026thinsp;22.23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConversion to laparotomy (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdditional trocar placement (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaximum tumor diameter (cm, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\:\\pm\\:\\:s\\)\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.67\u0026thinsp;\u0026plusmn;\u0026thinsp;1.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of dissected lymph nodes (n, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\:\\pm\\:\\:s\\)\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30.23\u0026thinsp;\u0026plusmn;\u0026thinsp;4.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncision length (cm, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\:\\pm\\:\\:s\\)\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOn the first postoperative day, patients were encouraged to mobilize early based on their individual conditions, with urinary catheters removed promptly. Small amounts of water were permitted to be imbibed and routine intravenous nutritional support was provided. Postoperative management included Zusanli (ST36) acupuncture point massage, rectal administration of glycerin enemas and other interventions to facilitate bowel function recovery and spontaneous flatus. Patients were transitioned to clear fluids and small amounts of a liquid diet as soon as possible. The abdominal drainage tube was removed once the daily drainage volume was less than 100 mL for two consecutive days. Postoperative outcomes are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePostoperative recovery outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndicator\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePatients (n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime to first flatus (h, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\:\\pm\\:\\:s\\)\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50.36\u0026thinsp;\u0026plusmn;\u0026thinsp;9.23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime to first ambulation (h, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\:\\pm\\:\\:s\\)\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38.59\u0026thinsp;\u0026plusmn;\u0026thinsp;8.19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime to first liquid diet (h, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\:\\pm\\:\\:s\\)\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67.95\u0026thinsp;\u0026plusmn;\u0026thinsp;11.19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative hospital stay (d, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\:\\pm\\:\\:s\\)\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.86\u0026thinsp;\u0026plusmn;\u0026thinsp;3.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime to drain removal (d, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\:\\pm\\:\\:s\\)\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.76\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePain scores (point, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\:\\pm\\:\\:s\\)\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12 h\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e24 h\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e48 h\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e72 h\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative complications within 30 days (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (18.18%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTypes of complications (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypoproteinemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (9.09%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePleural effusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (4.55%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWound infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (4.55%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeep vein thrombosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (4.55%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClavien-Dindo Classification (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eⅠ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (4.55%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eⅡ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (9.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eⅢ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (4.55%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWound healing score (CS score, n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (81.82%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedium\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (13.64%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (4.55%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTumor TNM stage (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eⅠ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (18.18%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eⅡ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (68.18%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eⅢ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (13.64%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eD2 radical gastrectomy for gastric cancer involves an extensive surgical field and complex lymphadenectomy, posing significant technical challenges for surgeons. It demands not only proficient laparoscopic surgical skills but also a thorough understanding of the anatomical structures under laparoscopy [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Furthermore, laparoscopic surgery eliminates tactile feedback, limits the surgical field of view due to insufficient retractor exposure and confines operations within a narrow and restricted visual space, factors which make gastric mobilization and lymph node dissection more challenging than traditional laparotomy. Therefore, close collaboration among the surgeon, first assistant and scope assistant is essential [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSince early 2017, our surgical team has developed and refined a \"Seven-Step\" procedural approach for laparoscopic D2 radical gastrectomy, introducing a structured and standardized concept [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This method segments lymphadenectomy into a series of orderly steps, which helps the surgeon maintain a clear operative strategy and ensures more thorough lymph node dissection, ultimately enhancing surgical safety [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Proceduralized surgery encompasses both the systematic organization of surgical steps and the coordinated efforts of the surgical team [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. By adhering to this systematic approach, the surgeon and assistants remain aligned in their strategies and actions throughout the procedure. This standardized surgical model offers multiple advantages. It minimizes intraoperative manipulation and clamping of the remnant stomach and intestines, thereby promoting postoperative gastrointestinal recovery [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Additionally, improved exposure and team coordination shorten operation times, prevent damage to adjacent organs, reduce the incidence of postoperative complications and accelerate patient recovery [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The implementation of standardized and structured procedures simplifies the surgical process, ensures clear and organized anatomical exposure, reduces surgical complexity and improves operational efficiency. Furthermore, this approach facilitates learning and dissemination in primary healthcare settings, promoting the adoption of advanced surgical techniques, optimizing the allocation of medical resources and enabling broader clinical applications.\u003c/p\u003e\u003cp\u003eSince Kitano first introduced laparoscopic techniques for the treatment of gastric cancer, this approach has garnered widespread attention and led to significant advances [\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. With the growing adoption of Enhanced Recovery After Surgery (ERAS) principles and an increasing demand for minimally invasive procedures, SILS has rapidly developed due to its minimally invasive advantages. However, SILS faces technical challenges, including the \"chopstick effect,\" \"coaxial effect,\" and difficulties in digestive tract reconstruction, which limit its broader application. To address these limitations, the dual-port laparoscopic technique has emerged as an effective alternative. By isolating the primary operating port, the dual-port approach minimizes instrument interference, enabling smoother surgical maneuvers and providing improved access for digestive tract reconstruction. Additionally, the independent drainage port eliminates the need for extra incisions, thereby reducing the postoperative burden on patients.\u003c/p\u003e\u003cp\u003eLymph node dissection remains a critical focus in radical gastrectomy for gastric cancer. Compared to the conventional five-port laparoscopic approach, this study reduces the number of trocar ports without compromising the use of surgical instruments. The procedure's success relies on seamless collaboration between the assistant and the lead surgeon. By implementing a standardized and streamlined surgical protocol, each region's exposure and dissection were performed in a systematic and efficient manner. Furthermore, the independent placement of the primary operating port below the left costal margin provided greater maneuverability, enhancing operational precision and flexibility. The dual-port approach, combined with the seven-step method for laparoscopic radical gastrectomy, optimized the surgical pathway and refined the sequence of lymph node dissection, significantly reducing the complexity of the procedure. The number of dissected lymph nodes in this study (30.23\u0026thinsp;\u0026plusmn;\u0026thinsp;4.99) was comparable to that achieved using the five-port seven-step robot-assisted radical gastrectomy technique (30.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, the limited sample size and lack of a control group in the present study necessitates further research and validation to confirm and expand upon the findings.\u003c/p\u003e\u003cp\u003eThe core principle of ERAS is to optimize perioperative management through multidisciplinary collaboration and evidence-based practices, aiming to facilitate rapid recovery, early discharge and a reduction in postoperative complications [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Postoperative pain is one of the primary stressors for patients [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The DPLRDG offers advantages such as smaller incisions and fewer wounds. Additionally, routine local anesthetic blockade around the wound at the end of the surgery significantly alleviates postoperative pain. This approach enables patients to ambulate earlier, promotes gastrointestinal function recovery and aligns well with the principles of ERAS.\u003c/p\u003e\u003cp\u003ePostoperative complications are key indicators for evaluating surgical outcomes and recovery. The present study included 22 patients, among whom 1 developed a small amount of pleural effusion after surgery, which resolved after oral diuretic treatment. Another patient experienced both hypoproteinemia and wound infection, treated successfully with albumin supplementation and wound care. One patient had hypoproteinemia alone and recovered after receiving human albumin supplementation. Additionally, 1 patient developed deep vein thrombosis (DVT), which was managed with the placement of an inferior vena cava filter. The occurrence of DVT may be attributed to the patient\u0026rsquo;s long-standing history of hypertension and diabetes, along with limited daily activity after first ambulating 53 h postoperatively. Importantly, no surgery-related complications such as anastomotic leakage or intra-abdominal bleeding were observed in the 22 patients. The overall complication rate was 18.18%, consistent with previously reported rates of complications in reduced-port laparoscopic radical gastrectomy for gastric cancer (4.1\u0026ndash;42.9%) [\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWound aesthetics are a significant advantage of the dual-port laparoscopic surgery. Compared to the conventional five-port approach, the dual-port method reduces the number of incisions and employs subcutaneous cosmetic suturing, thereby minimizing the risk of prominent scar formation. Among the 22 patients in the present study, 18 reported high satisfaction with their postoperative wounds. One patient experienced subcutaneous fat liquefaction, requiring daily wound dressing for one week. Although the wound eventually healed, this patient reported lower satisfaction.\u003c/p\u003e\u003cp\u003eIn summary, the dual-port laparoscopic approach, combined with the seven-step method is a viable option for radical distal gastrectomy. Preliminary studies suggest that its short-term efficacy and safety are comparable to those of the conventional five-port approach. Moreover, the reduced-port technique promotes faster recovery, less postoperative pain, and higher patient satisfaction with wound outcomes, aligning with ERAS principles. However, this study's small sample size and single-center design necessitate further multicenter, large-scale studies to validate its long-term efficacy and safety.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe seven-step method for dual-port laparoscopic radical distal gastrectomy is safe and feasible, offering minimal postoperative pain, favorable cosmetic outcomes and rapid recovery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the Gansu Provincial Hospital (approval number: 2024-319, date: March 16, 2024). All patients voluntarily opted for dual-port laparoscopic surgery and provided written informed consent prior to undertaking the procedure. All methods were carried out in accordance with Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data, materials and methods in this study can be made available from the corresponding author upon request for non-commercial purposes and after approval of study proposal through a signed data access agreement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported: Lanzhou Science and Technology Research and Development Program (2023-ZD-19);\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWentao Zhang and Hongwei Tian were involved in the conception and design; Xiong Li, Yuan Huo, Changfeng Miao were involved in the analysis and interpretation of data; Wentao Zhang, Yuan Huo, Changfeng Miao were involved in the drafting of the paper or revising; Wentao Zhang and Hongwei Tian were involved the Information Classification: General final approval of the version to be published; and that all authors agree to be accountable for all aspects of the work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGiuliani A, Miccini M, Basso L. Extent of lymphadenectomy and perioperative therapies: two open issues in gastric cancer. World J Gastroenterol. 2014;20:3889\u0026ndash;904.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, et al. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66:115\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim SM, Lee SH, Ha MH, Seo JE, Kim JE, Choi MG, et al. Techniques of the Single-Port Totally Laparoscopic Distal Gastrectomy. Ann Surg Oncol. 2015;22(Suppl 3):S341.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKong J, Wu SD, Su Y. Translumenal single-incision laparoscopy radical gastrectomy with D2 lymph node dissection for early gastric cancer\u0026ndash;primary experience with less invasive surgery in China. J Laparoendosc Adv Surg Tech A. 2013;23:141\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePark DJ, Lee JH, Ahn SH, Eng AK, Kim HH. Single-port laparoscopic distal gastrectomy with D1\u0026thinsp;+\u0026thinsp;β lymph node dissection for gastric cancers: report of 2 cases. Surg Laparosc Endosc Percutan Tech. 2012;22:e214\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee CM, Park DW, Jung DH, Jang YJ, Kim JH, Park S, et al. Single-Port Laparoscopic Proximal Gastrectomy with Double Tract Reconstruction for Early Gastric Cancer: Report of a Case. J Gastric Cancer. 2016;16:200\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eProfessional committee of. single incision laparoscopic surgery, minimally invasive medicine committee of chinese medical doctor association. Expert consensus on single incision plus one laparoscopic gastric cancer surgery (2020 version). J Laparosc Surg. 2021;26:7\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYan S, Ma XF, Zhao K, Chen XQ, Guo C, Wang QQ, et al. Analysis of technical difficulties of single-port and reduced port laparoscopic radical gastrectomy for gastric cancer. Chin J Dig Surg. 2019;18:222\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLin T, Yu J, Hu YF, Liu H, Lu YM, Zhao ML, et al. Preliminary experience of dual port laparoscopic distal gastrectomy for gastric cancer. Chin J Gastrointest Surg. 2019;22:35\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePark EJ, Kim CW, Cho MS, Kim DW, Min BS, Baik SH, et al. Is the learning curve of robotic low anterior resection shorter than laparoscopic low anterior resection for rectal cancer? a comparative analysis of clinicopathologic outcomes between robotic and laparoscopic surgeries. Med (Baltim). 2014;93:e109.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHuang XB, Hu M, Cai H, Zhan WP, Yang J, Ma YT. Programmedseven-step methodin distal radical gastrectomy with Da Vinci robot3\u0026thinsp;+\u0026thinsp;2mode. Chin J Clin Oncol. 2022;49:124\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDunker MS, Stiggelbout AM, van Hogezand RA, Ringers J, Griffioen G, Bemelman WA. Cosmesis and body image after laparoscopic-assisted and open ileocolic resection for Crohn's disease. Surg Endosc. 1998;12:1334\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKunisaki C, Makino H, Yamamoto N, Sato T, Oshima T, Nagano Y, et al. Learning curve for laparoscopy-assisted distal gastrectomy with regional lymph node dissection for early gastric cancer. Surg Laparosc Endosc Percutan Tech. 2008;18:236\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGoitein D, Mintz Y, Gross D, Reissman P. Laparoscopic adrenalectomy: ascending the learning curve. Surg Endosc. 2004;18:771\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTang LM, Qian J. The procedures and modeling of laparoscopic D2 radical gastrectomy in gastric cancer. Chin J Laparosc Surg (Electronic Edition). 2010;3:306\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi GL, Lin Q, Zheng SY, Zhou QB, Chen RF. The evaluation of laparoscopic pancreaticoduodenectomy with programmed process. Chin J Laparosc Surg (Electronic Edition). 2018;11:85\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhu CH, Huang CQ, Huang HW, Gao SQ, Xu JB, Cai ZR. Clinical application research of anatomical and programmed retroperitoneoscopic adrenalectomy by six-step procedure. China J Endoscopy. 2020;26:72\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYang YF, Wang WK, Zhao QX, Song LM, Xing NZ. Programmed laparoscopic radical cystectomy for bladder cancer: clinical experience summary of 120 cases. J Clin Urol. 2018;33:859\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCai M, Zeng XY, Xiong Z, Gao JB, Shuai XM, Cai KL, et al. Early postoperative complications and risk factors in laparoscopic D2 radical gastrectomy for gastric cancer. Chin J Gastrointest Surg. 2019;22:742\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang Q, Feng DB, He J, Wang XN, Zhang YF, Zhang J, et al. Comparison of the application effect of single incision\u0026thinsp;+\u0026thinsp;1 port and conventional laparoscopic surgery in radical gastrectomy for gastric cancer. Clin Res Pract. 2020;5:9\u0026ndash;103.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKitano S, Tomikawa M, Iso Y, Hashizume M, Moriyama M, Sugimachi K. Laparoscopy-assisted devascularization of the lower esophagus and upper stomach in the management of gastric varices. Endoscopy. 1994;26:470\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eExpert consensus on robotic surgery in gastric cancer. (2015 edition) Editorial committee. Expert consensus on robotic surgery in gastric cancer (2015 edition). Journal of Chinese Research Hospitals. 2016;3:22\u0026thinsp;\u0026ndash;\u0026thinsp;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEom BW, Yoon HM, Ryu KW, Lee JH, Cho SJ, Lee JY, et al. Comparison of surgical performance and short-term clinical outcomes between laparoscopic and robotic surgery in distal gastric cancer. Eur J Surg Oncol. 2012;38:57\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOmori T, Fujiwara Y, Moon J, Sugimura K, Miyata H, Masuzawa T, et al. Comparison of Single-Incision and Conventional Multi-Port Laparoscopic Distal Gastrectomy with D2 Lymph Node Dissection for Gastric Cancer: A Propensity Score-Matched Analysis. Ann Surg Oncol. 2016;23:817\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim SM, Ha MH, Seo JE, Kim JE, Choi MG, Sohn TS, et al. Comparison of single-port and reduced-port totally laparoscopic distal gastrectomy for patients with early gastric cancer. Surg Endosc. 2016;30:3950\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim HG, Kim DY, Jeong O. Transition from Conventional to Reduced-Port Laparoscopic Gastrectomy to Treat Gastric Carcinoma: a Single Surgeon's Experience from a Small-Volume Center. J Gastric Cancer. 2018;18:172\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Stomach neoplasms, Programmed seven-step method, Dual-port laparoscopic, Distal gastrectomy","lastPublishedDoi":"10.21203/rs.3.rs-7489791/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7489791/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo explore the short-term efficacy and safety of the programmed seven-step method in dual-port laparoscopic radical distal gastrectomy for gastric cancer.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis retrospective study was conducted on patients with distal gastric cancer admitted to Gansu Provincial People's Hospital from January 2020 to January 2022. The seven-step method for dual-port laparoscopic radical distal gastrectomy was performed under strict inclusion and exclusion criteria. Postoperative short-term outcomes, including surgery-related and recovery-related-indicators, were analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 22 patients successfully underwent dual-port laparoscopic radical distal gastrectomy using the seven-step method. The overall complication rate was 18.18%; however, no surgery-related complications occurred, and there was no conversion to laparotomy or additional trocar insertions required during the procedure. A high level of satisfaction with postoperative wound aesthetics was reported by 81.82% of the patients. The mean number of dissected lymph node was 30.23\u0026thinsp;\u0026plusmn;\u0026thinsp;4.99, the average operation time was 202.64\u0026thinsp;\u0026plusmn;\u0026thinsp;27.03 min and the intraoperative blood loss was 82\u0026thinsp;\u0026plusmn;\u0026thinsp;22.23 mL. The mean time to first ambulation was 38.59\u0026thinsp;\u0026plusmn;\u0026thinsp;8.19 h, the time to first flatus was 50.36\u0026thinsp;\u0026plusmn;\u0026thinsp;9.23 h, the average surgical incision length was 4.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63 cm and the average postoperative hospital stay was 8.86\u0026thinsp;\u0026plusmn;\u0026thinsp;3.04 days.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe seven-step method for dual-port laparoscopic radical distal gastrectomy is safe and feasible, offering minimal postoperative pain, favorable cosmetic outcomes and rapid recovery.\u003c/p\u003e","manuscriptTitle":"Application of the Seven-Step Method in Dual-Port Laparoscopic Radical Distal Gastrectomy for Gastric Cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-17 02:20:19","doi":"10.21203/rs.3.rs-7489791/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8d0a92a8-9f62-4095-b05b-976089e1fc85","owner":[],"postedDate":"October 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-20T05:08:14+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-17 02:20:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7489791","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7489791","identity":"rs-7489791","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}