Laparoscopic total gastrectomy with spleen-preserving splenic hilar (No. 10) lymph node dissection for gastric cancer is still a challenging procedure

To perform the laparoscopic surgery for locally advanced gastric cancer located in proximal third of the stomach, laparoscopic lymphadenectomy for splenic hilar lymph nodes is essential procedure. The important point of this procedure is how to perform it without injuring the splenic vessels and parenchyma of the spleen and pancreas. This video presentation shows meticulous dissection of the lymph nodes around the distal pancreas and spleen without bleeding. The laparoscopic technique in this video can provide insight into the challenge for surgeons. However, laparoscopic total gastrectomy for locally advanced gastric cancer still needs confirmative clinical evidence. Therefore, it should be performed for selected patients by the experienced surgeons.