RU2840124C1 - Method for performing longitudinal gastrectomy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to bariatric surgery. Gastrophrenic ligament is dissected to the left from the oesophagus. Omental sac is approached near a wall of a lower one-third of stomach with providing tension of the omentum by traction for it and an anterior wall of stomach downwards and upwards respectively. Stomach is mobilized along a greater curvature directly along the gastric wall with leaving no omentum portions on the gastric wall from a point of entering the omental sac towards the pylorus to the level of the angular notch so that to a pyloric sphincter there are 1-2 cm left. Longitudinal gastric fold is straightened in an antrum along an outer edge of a greater curvature at 2-4 cm from a pylorus. After the stomach is mobilised, a calibration probe with a sleeve formed thereon is inserted. End of probe is introduced into pylorus, probe is laid along lesser curvature. Gastrectomy is performed with a linear stapling apparatus with a variable curvature of a distal portion with uniformly stretching the stomach, and the first stapling is started at 1-2 cm from the pylorus. Stapler line is formed.

EFFECT: method provides higher stapler line consistency in the antral portion, reduced traumatism, reduced length of rehabilitation and reduced risk of postoperative complications by stretching the longitudinal gastric fold before the resection and reducing a distance from the pylorus.

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Description

Field of technology to which the invention relates

The proposed invention relates to medicine, namely to bariatric surgery, and can be used to treat obesity.

State of the art

Longitudinal gastrectomy (LG) is a bariatric operation with a restrictive mechanism, during which a gastric tube with a volume of 100-150 ml is formed, preserving the antral section. The mechanism of weight loss is due to the restrictive component, as well as the hormonal mechanism associated with a sharp decrease in ghrelin levels.

The effectiveness of bariatric surgery is demonstrated by numerous studies. Despite the high effectiveness of the described operations, there remains a risk of early and late postoperative complications. One of the most severe early complications is stapler line failure after longitudinal gastrectomy (LG), one of the possible causes being the incorrect choice of staple closure height. The incidence of complications after LG varies from 0.5 to 8%, and mortality when it occurs can reach up to 50%. Staple line failure is the most important independent risk factor for mortality after LG.

A known method for performing laparoscopic longitudinal resection of the stomach in morbid obesity (RU Patent for Invention No. 2759564, IPC class A61B 17/94, A61B 17/00, A61B 17/34, A61B 17/072, A61B 17/122, A61M 25/00, published on November 15, 2021) includes cutting off the greater curvature of the stomach with a linear stapling apparatus on a probe, installing trocars along the midline, left and right hypochondrium, with 4 trocars installed. The first trocar is placed 15 cm below the xiphoid process along the midline, the left trocar is placed in the right hypochondrium along the midaxillary line at the level of the pylorus, the atral part of the stomach. The right trocar is placed along the posterior axillary line below the costal arch at the level of the greater curvature of the stomach in the left hypochondrium. The upper trocar is placed along the midline in the area of the xiphoid process, with a puncture towards the left lobe of the liver. The stomach is mobilized along the greater curvature. The stomach is cut off along the greater curvature with an indentation of 5 cm from the pylorus. The stomach is sutured, forming a sleeve of uniform diameter. The cut stomach is removed, the wounds are sutured.

Disadvantages: increased surgical time, formation of a reservoir in the antral section, which is a factor in future heartburn and a risk factor for weight gain, ischemia of the staple line of the antral section of the stomach.

A method of single-port longitudinal gastrectomy using standard laparoscopic instruments is known (RU Patent for Invention No. 2793928, IPC class A61B 17/00, A61B 1/313, A61B 17/125, A61B 17/068, A61B 17/34, A61B 17/122, A61P 23/02, published 10.04.2023), during which a 10 mm trocar is installed through a transumbilical approach for inserting optics, and a 5 mm trocar for a laparoscopic clamp is installed 1 cm to the left of it in another plane. A 5 mm trocar for a Harmonic ultrasonic scalpel is installed 1 cm to the right of the trocar for optics. The left lobe of the liver is sutured to the anterior abdominal wall with a furrier's needle. Then, the stomach is mobilized along the greater curvature with an ultrasonic scalpel, after which the left 5 mm trocar is replaced with a 12 mm trocar intended for inserting a stapling apparatus. The stomach is tractioned with a clamp through the right 5 mm trocar. A calibration probe is inserted into the stomach before cutting it off with a stapling apparatus. The stapling apparatus is inserted through the 12 mm trocar and, taking into account the anatomy, the angle of its curvature is adjusted to perform a full longitudinal resection. Peritonization of the apparatus suture is performed with a notched thread. The stomach is removed from the abdominal cavity through a combined access between the right and central trocar, while the size of the access does not exceed the diameter of the resected stomach. The postoperative aponeurosis defect is sutured with interrupted sutures, and the skin is sutured with a cosmetic intradermal suture.

Disadvantages: increased operation time, formation of a reservoir in the antral region, which is a factor in heartburn and weight gain, limited indications (BMI no more than 40 kg/ ^m2 ), impossibility of performing this technique in cases of super obesity.

The general disadvantage is the relatively low consistency of the stapler suture line, high trauma, long healing and rehabilitation periods. The indentation from the pylorus is 4-5 cm, which in the future is a risk factor for the formation of a reservoir for the occurrence of heartburn, as well as a factor for repeated weight gain, decreased quality of life, and disruption of comfort of eating.

Disclosure of invention

The technical result of the proposed invention is to increase the consistency of the stapler suture line in the antral section, the distance from the pylorus is 1-2 cm, which prevents the formation of a reservoir in the antral section and promotes effective weight loss, reduced trauma and, as a result, a reduction in the rehabilitation period and a reduction in the risk of developing early and late postoperative complications.

The said technical result is achieved due to the fact that the method for performing longitudinal gastrectomy is characterized by the fact that a laparoscope and trocars are installed and access is provided to the abdominal cavity, the patient is placed in the reverse Trendelenburg position; a liver retractor is inserted into the abdominal cavity through a subxiphoid trocar; the liver is retracted with a retractor, the fundus of the stomach is pulled with an atraumatic clamp and the gastrodiaphragmatic ligament is dissected with an ultrasonic scalpel to the left of the esophagus; access is provided to the omental bursa using an ultrasonic scalpel near the wall of the lower third of the stomach, while providing tension of the omentum due to traction on it and on the anterior wall of the stomach downwards and upwards, respectively; mobilization of the stomach along the greater curvature is performed directly along the wall of the stomach, without leaving any sections of the omentum on the wall of the stomach, from the point of entry into the omental bursa towards the pylorus to the level of the angular notch so that 1-2 cm remain to the pyloric sphincter; The longitudinal fold of the stomach located in the antral part of the stomach along the outer edge of the greater curvature at a distance of 2-4 cm from the pylorus is straightened; after mobilization of the stomach, a calibration probe is inserted, on which a “sleeve” is formed, the end of the probe is inserted into the pylorus, the probe is placed along the lesser curvature; gastric resection is performed using a linear stapling apparatus with a variable curvature of the distal part, while the stomach is uniformly stretched, and the first suturing begins 1-2 cm from the pylorus; a stapler line is formed; the calibration probe is removed from the lumen of the gastric stump; the resected fragment of the stomach is extracted through a retractor installed at the site of the trocar on the left.

A 5-port approach can be used during the resection process.

Access to the abdominal cavity can be achieved by placing an optical 12 mm trocar along the left midclavicular line midway between the umbilicus and the costal arch under visual control of an operating laparoscope with an optical axis angle of 0°.

The Harmonic brand scalpel can be used as an ultrasonic scalpel.

The Ligasure brand instrument can be used as a gastric mobilization instrument.

The diameter of the calibration probe can be 38 Fr.

To form a staple line, staples of 3.8 mm and 4.1 mm height can be used.

To form a stapler line at the beginning of suturing, in the distal part of the stomach, staples of 4.1 mm height can be used, and at the end of suturing, in the proximal parts, staples of 3.8 mm height can be used.

Brief description of the drawings

Fig. 1 shows a photo of the stage of stomach mobilization of the method for performing longitudinal resection of the stomach. In the photo, the longitudinal fold of the stomach is indicated by a blue line.

Fig. 2 shows photos of manipulations to straighten the longitudinal fold of the stomach in the antral section.

a) using two clamps, the stage of straightening the longitudinal fold is started;

b) the stage of straightening the longitudinal fold in the distal direction;

c) the stage of straightening the longitudinal fold: you can see how the back wall of the stomach gathers into a bulb, which thickens it;

d) stage of straightening the longitudinal fold: it shows how the stomach wall straightens;

d) stage of straightening the longitudinal fold: complete straightening of the stomach wall.

Implementation of the invention

The quality of the operation depends primarily on the skills and knowledge of the surgeon, but the quality of the instruments and understanding of the anatomy of the stomach and the sequence of stages of the operation are no less important.

The PRZh technique is associated with compliance with the main factors:

- position of the patient and the surgeon;

- position of trocars and instruments;

- knowledge of the features of laparoscopic anatomy of the abdominal cavity.

The PRZ is performed in the traditional way. In the traditional way, the first stage is mobilization of the stomach along the greater curvature, and then resection.

As a rule, a 5-port approach is used. Access to the abdominal cavity is obtained by installing a laparoscope under visual control with an optical axis angle of 0° and an optical 12 mm trocar along the left midclavicular line in the middle between the umbilicus and the costal arch.

After gaining access to the abdominal cavity and installing trocars, the patient is placed in the reverse Trendelenburg position.

Instruments and a laparoscope are inserted through the established ports. A liver retractor is inserted into the abdominal cavity through the subxiphoid trocar, the liver is retracted, and the first stage of the operation begins.

Stages of the operation:

1) mobilization of the gastrodiaphragmatic ligament, Lymer-Bertelli membrane;

2) access to the omental bursa;

3) mobilization of the stomach along the greater curvature with straightening of the longitudinal gastric fold;

4) laying the calibration probe;

5) gastric resection;

6) strengthening the stapler line;

7) removal of the calibration probe;

8) removal of the resected stomach.

The following instruments are used during the operation: a disposable 60 mm suturing apparatus and cassettes for it; a tip of an ultrasonic dissector; a tip of an instrument for electroligation of vessels and two disposable 12 mm trocars.

Mobilization begins with dissection of the gastrodiaphragmatic ligament to the left of the esophagus using an ultrasonic scalpel (e.g., Harmonic). Performing this manipulation at the very beginning of the operation is very important, since an undissected gastrodiaphragmatic ligament complicates further mobilization in the area of the gastrosplenic ligament and short gastric arteries, preventing the necessary traction. When performing this manipulation, the assistant retracts the liver with a retractor and stretches the fundus of the stomach with an atraumatic clamp.

Access to the omental bursa is provided using an ultrasonic scalpel near the wall of the lower third of the stomach. In this case, the surgeon and assistant provide tension to the omentum by traction on it and on the anterior wall of the stomach downwards and upwards, respectively.

Mobilization of the stomach along the greater curvature using an instrument for electroligation of vessels (for example, the Ligasure brand). Mobilization is performed directly along the wall of the stomach, while it is important not to leave areas of the omentum on the wall of the stomach, as they easily bleed when traction is applied to them.

Mobilization is performed along the greater curvature from the point of entry into the omental bursa towards the pylorus to the level of the angular notch (incisura angularis) so that several centimeters (1-2 cm) remain to the pyloric sphincter. When mobilizing in this area, attention should be paid to the posterior wall of the stomach, where the longitudinal fold is located, the frequency of occurrence during operations is 95% of cases (previously not described in anatomical atlases).

The longitudinal fold of the stomach is visualized in the antral section along the posterior wall of the stomach, along the outer edge of the greater curvature, at a distance of 2-4 cm from the pylorus (see photo in Fig. 1). The fold gathers into a bulb in the pylorus zone, which significantly thickens the wall of the stomach. Its straightening is mandatory, surgically significant for performing operations in this zone, primarily for the prevention of insolvency in this zone. It is in this anatomical area that the first suturing with a suturing device occurs - the beginning of the resection stage. When the longitudinal fold of the stomach is straightened, the posterior wall straightens and the wall becomes thinner, which allows for adequate suturing in this zone without tension and maintaining the integrity of all layers of the stomach wall.

Only after this fold of the stomach has been straightened is the stage of stomach mobilization considered complete.

After mobilization of the stomach, the anesthesiologist inserts a calibration probe with a diameter of 38 Fr (according to the Charriere scale), on which a “sleeve” is formed. The end of the probe is inserted into the pylorus, and the probe itself is placed along the lesser curvature.

Gastric resection is performed using a linear suturing device with a variable curvature of the distal part, which ensures the best tension of the stomach on the calibration probe and a uniform diameter of the remaining gastric tube.

The tension of the stomach is carried out by the surgeon and assistant, and it is necessary to strictly ensure that the tension is uniform and that no wall enters the stapler in a larger portion than the other, as this can lead to kinking of the gastric tube and increases the risk of stapler line failure.

To form a stapler line, a combination of cassettes with different staple heights can be used ("gold" 3.8 mm, "green" 4.1 mm, "black" 4-4.5-5 mm), with higher staples used at the beginning of the suturing, i.e. in the distal part of the stomach, where it is collected into a bulb due to the longitudinal fold described above, and lower ones - at the end, in the proximal parts. The operation can also be performed using one staple height - 4.1 mm ("green" cassette).

When suturing in the area of the angle of His, special attention is paid to eliminating the formation of a residual pocket, which can form due to insufficient tension of the fundus of the stomach.

The operation is completed by removing the calibration probe from the lumen of the gastric stump under visual control, while an active inspection of the “sleeve” is performed.

The resected gastric fragment is removed through a 25 mm retractor installed in place of the 12 mm trocar on the left.

Rules of surgical technique when performing PRZ:

1. Use a calibration probe, the optimal size of the bougie is 38 Fr.

2. Resection can only be started with complete mobilization of the fundus of the stomach and intersection of the short gastric vessels.

3. Resection should begin (first suturing) 1-2 cm from the pylorus only after straightening the gastric fold.

4. When suturing the last cassette, it is necessary to avoid placing the suturing device on the esophagogastric junction.

5. Stretching of the stomach walls should be uniform relative to the axis of the stomach in order to prevent torsion.

6. The stapler line is sutured only if there is a probe in the lumen of the stomach in order to prevent a decrease in the volume of the gastric tube.

Examples of implementation

1. Patient D., female, born in 1993, height 164 cm, weight 114 kg, BMI (body mass index) 42.4 kg/ ^m2 , underwent longitudinal gastrectomy on February 7, 2022, in accordance with the stated method. The patient underwent PRG, the first suturing was performed at an indentation of 2 cm from the pylorus, the gastric fold was straightened, suturing was performed with the Endopath Echelon Flex 60 stapler using a “green” cassette (staple height 4.1 mm) and a “gold” cassette (staple height 3.8 mm). In this case, the integrity and complete suturing of the gastric wall were observed. Since the thickness of the gastric wall in the antral section is the thickest, and in the presence of a gastric fold, its straightening significantly thins the thickness of the gastric wall, which minimizes the risk of violating the integrity of the wall during suturing. Also, straightening the fold allows the first stitching to be performed at a distance of 1-2 cm from the pylorus, while minimizing the formation of a “pocket” in the antral region.

The operation lasted 50 minutes. The patient was mobilized two hours after the operation. The postoperative period was smooth. Discharged on the 4th day.

Under endotracheal anesthesia, pneumoperitoneum was imposed with intra-abdominal pressure of 14 mm Hg. Trocars were inserted - 12 mm in the right hypochondrium, 10 mm along the midline 15 cm below the xiphoid process, 5 mm subxiphoidally, 5 mm in the left hypochondrium along the anterior axillary line, 12 mm in the left hypochondrium along the midclavicular line. During revision of the abdominal cavity - the left lobe of the liver is slightly enlarged, with a rounded edge, the stomach is located normally. The omental sac was opened along the greater curvature, then gastrolysis was performed with lumen control using the Ligasure bipolar instrument, mobilization of the fundus in the area of the spleen was performed with a HarmonicAce harmonic ultrasonic scalpel. A 38 F calibration probe was inserted into the stomach. The stomach was resected along the probe, starting from the mobilization site, using the Endopath Echelon Flex 60 stapler with 5 cassettes (4 “green” cassettes and 1 “gold” cassette were used). The stapler line was sutured with a single-row continuous suture. The specimen was removed through an adapter installed at the site of the 12 mm port in the left hypochondrium. Trocars and instruments were removed from the abdominal cavity. Layer-by-layer wound suturing. Aseptic dressing.

As a result, the weight loss of patient D. was (in relation to excess weight):

1. after 3 months - 47%,

2. after 6 months - 81.3%,

3. after 9 months - 94.1%,

4. after 12 months - 100.5%,

5. after 18 months - 111.2%,

6. after 24 months - 111.2%.

2. Patient B., female, born in 1992, height 158 cm, weight 114 kg, BMI 45.7 kg/ ^m2 , underwent laparoscopic longitudinal gastrectomy on December 20, 2022, in accordance with the stated method. The first suturing was performed with an indentation of 1 cm from the pylorus; staples of 4.1 mm in height were used to form a stapler line at the beginning of the suturing, in the distal part of the stomach, and staples of 3.8 mm in height were used at the end of the suturing, in the proximal parts.

Under endotracheal anesthesia, pneumoperitoneum was imposed with intra-abdominal pressure of 14 mm Hg. Trocars were inserted - 12 mm in the right hypochondrium, 10 mm along the midline 15 cm below the xiphoid process, 5 mm subxiphoidally, 5 mm in the left hypochondrium along the anterior axillary line, 12 mm in the left hypochondrium along the midclavicular line. During revision of the abdominal cavity - the left lobe of the liver is slightly enlarged, with a rounded edge, the stomach is located normally. The omental sac was opened along the greater curvature, then gastrolysis was performed with lumen control using the Ligasure bipolar instrument, mobilization of the fundus in the area of the spleen was performed with a HarmonicAce harmonic ultrasonic scalpel. A 38 F calibration probe was inserted into the stomach. The stomach was resected along the probe, starting from the mobilization site, using the Endopath Echelon Flex 60 stapler with 5 cassettes (4 “green” cassettes and 1 “gold” cassette were used). The stapler line was sutured with a single-row continuous suture. The specimen was removed through an adapter installed at the site of the 12 mm port in the left hypochondrium. Trocars and instruments were removed from the abdominal cavity. Layer-by-layer wound suturing. Aseptic dressing.

As a result, the weight loss was:

1. after 3 months - 44.6%,

2. after 6 months - 60.1%,

3. after 9 months - 69.8%,

4. after 12 months - 75.6%,

5. after 18 months - 83.3%.

3. Patient M, female, born in 1998 , height 167 cm, weight 120 kg, BMI 43 kg/ ^m2 , underwent laparoscopic longitudinal gastrectomy on September 28, 2022, in accordance with the stated method. The first suturing was performed with an indentation of 2 cm from the pylorus; staples 4.1 mm high were used to form a stapler line at the beginning of suturing, in the distal part of the stomach.

Under endotracheal anesthesia, pneumoperitoneum was imposed with intra-abdominal pressure of 14 mm Hg. Trocars were inserted - 12 mm in the right hypochondrium, 10 mm along the midline 15 cm below the xiphoid process, 5 mm subxiphoidally, 5 mm in the left hypochondrium along the anterior axillary line, 12 mm in the left hypochondrium along the midclavicular line. During revision of the abdominal cavity - the left lobe of the liver is slightly enlarged, with a rounded edge, the stomach is located normally. The omental sac was opened along the greater curvature, then gastrolysis was performed with lumen control using the Ligasure bipolar instrument, mobilization of the fundus in the area of the spleen was performed with a HarmonicAce harmonic ultrasonic scalpel. A 38 F calibration probe was inserted into the stomach. Along the probe, starting from the mobilization site, the stomach was resected using the Endopath Echelon Flex 60 stapler using 6 cassettes (5 “green” cassettes and 1 “gold” cassette were used). The stapler line was sutured with a single-row continuous suture. The specimen was removed through an adapter installed at the site of the 12 mm port in the left hypochondrium. Trocars and instruments were removed from the abdominal cavity. Layer-by-layer wound suturing. Aseptic dressing.

As a result, the weight loss was:

1. after 3 months - 47.7%,

2. after 6 months - 67.6%,

3. after 9 months - 81.5%,

4. after 12 months - 91.5%,

5. after 18 months - 93.5%,

6. after 24 months - 95.5%.

4. Patient 3., m., born in 1982, height 184 cm, weight 142 kg, BMI 41.9 kg/ ^m2 , underwent laparoscopic longitudinal gastrectomy on February 25, 2022, in accordance with the stated method. The first suturing was performed with an indentation of 2 cm from the pylorus; staples of 4.1 mm and 3.8 mm in height were used to form a stapler line at the beginning of suturing, in the distal part of the stomach.

Under endotracheal anesthesia, pneumoperitoneum was imposed with intra-abdominal pressure of 14 mm Hg. Trocars were inserted - 12 mm in the right hypochondrium, 10 mm along the midline 15 cm below the xiphoid process, 5 mm subxiphoidally, 5 mm in the left hypochondrium along the anterior axillary line, 12 mm in the left hypochondrium along the midclavicular line. During revision of the abdominal cavity - the left lobe of the liver is slightly enlarged, with a rounded edge, the stomach is located normally. The omental sac was opened along the greater curvature, then gastrolysis was performed with lumen control using the Ligasure bipolar instrument, mobilization of the fundus in the area of the spleen was performed with a HarmonicAce harmonic ultrasonic scalpel. A 38 F calibration probe was inserted into the stomach. The stomach was resected along the probe, starting from the mobilization site, using the Endopath Echelon Flex 60 stapler with 5 cassettes (4 “green” cassettes and 1 “gold” cassette were used). The stapler line was sutured with a single-row continuous suture. The specimen was removed through an adapter installed at the site of the 12 mm port in the left hypochondrium. Trocars and instruments were removed from the abdominal cavity. Layer-by-layer wound suturing. Aseptic dressing.

As a result, the weight loss was:

1. after 3 months - 55.8%,

2. after 6 months - 78.5%,

3. after 9 months - 90.7%,

4. after 12 months - 87.2%,

5. after 18 months - 87.2%,

6. after 24 months - 90.7%.

When mobilizing in the distal part of the stomach, attention should be paid to the posterior wall of the stomach, where the longitudinal fold of the stomach is located (previously not described in anatomical atlases). Its straightening is mandatory, surgically significant for performing operations in this area.

Thus, as a result of performing the PRG operations using the claimed method, it was established that a significant contribution to ensuring an increase in the consistency of the stapler suture line, in the choice of the height of staple closure, in reducing trauma, the rehabilitation period and the risk of complications, is made by straightening the longitudinal fold of the stomach.

A comparative analysis of the claimed technical solution showed that the set of essential features of the claimed method is not known from the state of the art and therefore meets the patentability condition “Novelty”.

The prior art did not reveal any features that coincide with the distinctive features of the claimed method and affect the achievement of the claimed technical result, therefore the claimed invention complies with the patentability requirement “Inventive step”.

The information provided confirms the possibility of using the claimed method for performing longitudinal resection of the stomach in bariatric surgery for the treatment of obesity, and therefore complies with the patentability condition “Industrial applicability”.

Claims (8)

1. A method for performing longitudinal resection of the stomach, characterized by the fact that a laparoscope and trocars are installed and access is gained into the abdominal cavity, the patient is placed in the reverse Trendelenburg position; a liver retractor is inserted into the abdominal cavity through a subxiphoid trocar; the liver is retracted with a retractor, the fundus of the stomach is pulled tight with an atraumatic clamp and the gastrodiaphragmatic ligament is dissected with an ultrasonic scalpel to the left of the esophagus; access is gained into the omental bursa using an ultrasonic scalpel near the wall of the lower third of the stomach, while ensuring tension of the omentum due to traction on it and on the anterior wall of the stomach downwards and upwards, respectively; mobilization of the stomach along the greater curvature is performed directly along the wall of the stomach, without leaving any areas of the omentum on the wall of the stomach, from the point of entry into the omental bursa towards the pylorus to the level of the angular notch so that 1-2 cm remain to the pyloric sphincter; The longitudinal fold of the stomach located in the antral part of the stomach along the outer edge of the greater curvature at a distance of 2-4 cm from the pylorus is straightened; after mobilization of the stomach, a calibration probe is inserted, on which a “sleeve” is formed, the end of the probe is inserted into the pylorus, the probe is placed along the lesser curvature; gastric resection is performed using a linear stapling apparatus with a variable curvature of the distal part, while the stomach is uniformly stretched, and the first suturing begins 1-2 cm from the pylorus; a stapler line is formed; the calibration probe is removed from the lumen of the gastric stump; the resected fragment of the stomach is extracted through a retractor installed at the site of the trocar on the left. 2. The method according to paragraph 1, characterized in that a 5-port access is used during the resection process. 3. The method according to item 1, characterized in that access to the abdominal cavity is achieved by installing an optical 12 mm trocar along the left midclavicular line in the middle between the navel and the costal arch under visual control of an operating laparoscope with an optical axis angle of 0°. 4. The method according to item 1, characterized in that a Harmonic brand scalpel is used as an ultrasonic scalpel. 5. The method according to paragraph 1, characterized in that the instrument used for mobilizing the stomach is a Ligasure brand instrument. 6. The method according to item 1, characterized in that the diameter of the calibration probe is 38 Fr. 7. The method according to paragraph 1, characterized in that staples of 3.8 mm, 4.1 mm height are used to form the staple line. 8. The method according to paragraph 1, characterized in that staples of 4.1 mm height are used to form a stapler line at the beginning of suturing, in the distal section of the stomach, and staples of 3.8 mm height are used at the end of suturing, in the proximal sections.