OPERATION: Laparoscopic Total Gastrectomy with D2 Lymphadenectomy and Roux-en-Y Oesophagojejunostomy
ANAESTHETIC: General anaesthesia with epidural
ANTIBIOTICS: IV at induction
POSITION: Supine, split-leg position with footpads. Urinary catheter. VTE prophylaxis.
INDICATION:
Gastric adenocarcinoma [location, Siewert type if applicable]. Preoperative staging: CT [staging], EUS [uT / uN stage], PET [if advanced]. [Neoadjuvant chemotherapy completed]. Laparoscopic staging with peritoneal washings previously confirmed negative for metastatic disease.
PROCEDURE:
WHO Checklist performed. Abdomen prepared and draped.
PORT PLACEMENT:
Five ports inserted across the lower abdomen: four 5 mm ports and one 12 mm port. CO₂ pneumoperitoneum at 15 mmHg. Nathanson liver retractor placed via 3 mm sub-xiphoid stab incision. Patient placed in steep reverse Trendelenburg.