The wonderful use of surgical gloves in total gastrectomy

For laparoscopic total gastrectomy, minimal invasive procedures are a significant technical challenge and requirement.

However, there are many drawbacks in traditional surgical procedures in the past.

Firstly, due to the uncertain induction and maintenance of anesthesia under pneumoperitoneum, and the loose seal around the tubular stapler rod, CO2 is likely to leak from the incision, resulting in loss of surgical field of view or frequent insertion of the tubular stapler outside the jejunal loop (therefore, this surgery should be defined as "endoscopic assisted").

Secondly, in traditional surgical procedures, it is necessary to enlarge the left puncture site for removal, usually to 3-4 cm, and in some cases, the incision needs to be enlarged to 6 cm.

As a result, due to the back and forth movement or rotation of the tubular stapler at the incision site, the enlarged edge of the incision is often torn apart, enlarged, or damaged.

Eight major advantages

Advantage 1: Due to the reliance on the enlarged left port for minimally invasive surgical procedures, the excised surgical specimen can be extracted earlier.

Advantage 2: Thanks to the establishment of a surgical glove port afterwards, a tubular stapler can be inserted into one of the finger positions of this glove during surgery to complete the firing of the tubular stapler and anastomosis operation, which is a form of protection for the incision. Importantly, the use of surgical gloves as a port makes it easier to hold the stapler stem during surgery.

Advantage 3: Compared to traditional procedures, thanks to the soft latex gloves, intraoperative operations can be performed in a more relaxed space, resulting in a safer and more accurate anastomosis of the esophagus and jejunum using a stapler.

Advantage 4: Compared with traditional surgery that directly inserts a tubular stapler through the abdominal wall incision without protection, this innovation makes the entire surgical process cleaner and neater. During the insertion and extraction of the tubular stapler anastomosis operation, contamination of the surgical incision is avoided, greatly reducing the risk of incision infection or tumor implantation metastasis.

Advantage 5: Better sealing effect greatly reduces the probability of air leakage, thereby ensuring the stability of the pneumoperitoneum.

Advantage 6: When the tube stapler is inserted into a protected incision, the use of the other finger of this glove to recycle the previous punch card (as shown in Figure 2) can fully avoid the trouble caused by missing one punch card. If it is still not enough, you can even use the other finger of this glove, which allows more forceps and endoscopic equipment to be utilized during the operation.

Advantage 7: Before inserting the incision protector, due to the continuous use of muscle separation technology, the damage to the abdominal wall incision and abdominal wall muscles is greatly reduced. In traditional surgery, in order to allow the insertion of a 25mm tubular stapler, the incision on the left abdominal wall must be enlarged to a length sufficient to complete the operation, and there is no punch card that can be inserted into such a large incision again.

Advantage 8: Use gloves as a port to insert the stapler. After completing the E-J anastomosis, there is no need to additionally close the port for inserting the tubular stapler, avoiding loss of pneumoperitoneum and surgical field of view caused by loss of pneumoperitoneum.