Are intraoperative abdominal radiographs necessary for identification of clips during totally laparoscopic or robotic gastrectomy?

As long-term oncological safety has been confirmed over time, laparoscopic or robotic gastrectomy has become a standard option in treatment of early gastric cancer (EGC) [1,2]. EGC is defined as a malignancy invading the mucosa and submucosal layer, regardless of lymph node metastasis [3]. Because of the shallow depth of the tumor, it is difficult to determine the exact location of the lesion by simply touching the serosa with surgical instruments during total laparoscopic or robot surgery [4]. Therefore, it is important to use an adequate tumor localization method to ensure adequate proximal resection lines during intracorporeal anastomosis. For total laparoscopic or robotic surgery, there are several methods for localization of the tumor [5-7], such as endoscopic tattooing, intraoperative endoscopy, or ultrasonography. However, the blurring effect of tattoo ink or need for additional equipment and endoscopists for intraoperative endoscopy have made the preopOriginal Article Korean Journal of Clinical Oncology 2019;15:49-55 https://doi.org/10.14216/kjco.19010 pISSN 1738-8082 ∙ eISSN 2288-4084