A multi-joint endoscopic surgical instrument for single-port D2 distal gastrectomy: Technical note with a video vignette

The execution of single-port laparoscopic gastrectomy (SPLG) for gastric cancer poses a considerable challenge, mainly attributed to the restricted availability and maneuverability of surgical instruments. To address this issue, our center has introduced the use of a multi-joint endoscopic surgical instrument (MJESI), for single-incision D2 distal gastrectomy. This study documents the integration of the MJESI, along with a suspension technique and surgical procedures that build upon our previously reported methodologies. A companion video is provided to offer a detailed illustration of these innovative techniques and procedures, enhancing comprehensive understanding. The MJESI significantly enhances surgical visualization and operational ergonomics. When combined with the dual-suspension technology and procedures developed by our team, SPLG can be performed more efficiently, thereby facilitating a shortened learning curve. The front clamps of the MJESI feature 360° rotation, enabling precise identification and manipulation of critical anatomical structures. The patient resumed oral intake on the third postoperative day and was discharged without any evident postoperative complications. The MJESI facilitates the performance of SPLG, which is challenging with conventional instruments, making SPLG significantly easier and more feasible.