Multimedia Journal of Metaverse in MEDICINE
METHODOLOGY | JANUARY 13, 2026
Laparoscopic gastric tumor resection: entry into the omental bursa and preservation of the gastroepiploic vessels
Gang Xu¹, Ruixiang Tang¹, Hao Zhang¹, Yong Zhang¹*
1 Department of Surgical Oncology, The First Affiliated Hospital of Xi’an JiaoTong University, Xi’an 710061, China.
Corresponding Authors: Yong Zhang. E-mail: [email protected]
Address: Department of Surgical Oncology, The First Affiliated Hospital of Xi’an JiaoTong University, Xi’an 710061, China.
Summary
Laparoscopic gastric tumor resection is a fundamental procedure in gastric cancer surgery, and its success relies on proper entry into the omental bursa and protection of the gastroepiploic vascular arcade. Due to the complex anatomy of the gastrocolic ligament and its proximity to the transverse mesocolon, improper manipulation may lead to bleeding, mesenteric injury, or inadequate tumor exposure. Based on one surgical video of laparoscopic gastric tumor resection, this study provides a multi perspective analysis (first person view, assistant view, and microscopic close up) of the key techniques for entering the omental bursa and preserving the gastroepiploic vessels. The results demonstrated that dividing the greater omentum along the lateral side of the gastroepiploic arcade, creating a window in the avascular area of the gastrocolic ligament to enter the omental bursa, and gradually mobilizing the greater curvature allowed complete preservation of the vascular arcade and adequate tumor exposure. This video based analysis offers an intuitive and educational reference for standardizing laparoscopic gastric tumor resection.
Keywords
Gastric tumor resection; laparoscopy; omental bursa; gastroepiploic vessels; gastrocolic ligament
Introduction
Laparoscopic gastric tumor resection is a common treatment for early gastric cancer and benign gastric tumors, and it also serves as the initial step of radical gastrectomy for advanced gastric cancer. The first critical step of this procedure is mobilization of the greater curvature of the stomach, which involves division of the greater omentum, entry into the omental bursa, and preservation of the gastroepiploic vascular arcade. Although these maneuvers appear basic, improper handling can result in injury to the gastroepiploic vessels, bleeding, tearing of the transverse mesocolon, or inadequate tumor exposure, all of which may compromise subsequent surgical steps.
The omental bursa (lesser sac) is a potential space posterior to the stomach. Correct entry into the omental bursa is essential for mobilizing the posterior gastric wall and exposing the tumor. In open surgery, the surgeon can perform blunt dissection with fingers, but in laparoscopic surgery, the lack of tactile feedback requires clear visual anatomical landmarks and precise instrument manipulation.
Studies have shown that injury to the gastroepiploic arcade during greater curvature mobilization may compromise blood supply to the remnant stomach or the gastric conduit, potentially increasing the risk of anastomotic leakage. Moreover, accidental entry into the transverse mesocolon can lead to unnecessary bleeding and prolong operative time. Therefore, a standardized approach to omental bursa entry and vessel preservation is needed.
This study is based on one surgical video of laparoscopic gastric tumor resection. Through multi‑perspective analysis including the first‑person view of the chief surgeon, the assistant‘s view, and microscopic close‑ups, we systematically demonstrate the key technical points for entering the omental bursa and protecting the gastroepiploic vessels, providing a reproducible technical framework for gastrointestinal surgeons.
Methods
1 Research Design
This study analyzed one surgical video of laparoscopic gastric tumor resection performed at the Department of Surgical Oncology, the First Affiliated Hospital of Xi’an JiaoTong University in June 2024. The patient was diagnosed with a gastric body tumor (cT1N0M0) and underwent laparoscopic wedge resection. Cases with tumor invasion into the surrounding organs or previous abdominal surgery were excluded.
2 Surgical team and equipment
The surgery was performed by a senior gastrointestinal surgical team. Equipment included a high definition 4K laparoscopic system (Olympus, Tokyo, Japan), laparoscopic ultrasonic shears (Harmonic ACE, Ethicon, Cincinnati, OH, USA), and standard laparoscopic graspers.
3 Surgical steps
(1) Patient positioning and port placement:The patient was placed in a lithotomy position with a reverse Trendelenburg tilt of 15–20°. A five‑port technique was used: one 10‑mm camera port at the umbilicus, two 5‑mm working ports in the left and right upper quadrants, and two 5‑mm assistant ports in the left and right lower quadrants. Pneumoperitoneum was established at 12 mmHg.
(2) Identification of landmarks:The transverse colon was identified, and the gastrocolic ligament was visualized. The gastroepiploic vascular arcade running along the greater curvature of the stomach was identified. The avascular area of the gastrocolic ligament between the gastric wall and the transverse mesocolon was located.
(3)Entry into the omental bursa:Using ultrasonic shears, the greater omentum was divided along the lateral side of the gastroepiploic arcade, leaving the arcade intact on the gastric side. A window was created in the avascular area of the gastrocolic ligament. Through this window, the posterior wall of the stomach and the anterior surface of the pancreas were exposed, confirming entry into the omental bursa.
(4) Mobilization of the greater curvature: Starting from the mid‑portion of the greater curvature, the stomach was gradually lifted anteriorly and superiorly. The connective tissue between the stomach and the transverse mesocolon was divided using blunt dissection and ultrasonic shears. The gastroepiploic vessels were carefully preserved. The mobilization proceeded toward the pylorus and toward the lower esophagus as needed for tumor exposure.
(5) Tumor localization and resection: The tumor was identified on the anterior or posterior gastric wall. The planned resection margins were marked, and the tumor was resected using a laparoscopic linear stapler or ultrasonic shears, depending on tumor size and location.
4 Data collection and analysis
The surgery was recorded from three perspectives:
（1）First person perspective (head mounted camera worn by the chief surgeon)
（2）Surgical assistant perspective (standard laparoscopic camera feed)
（3）Microscopic close up (magnified view of the gastrocolic ligament and omental bursa entry site)
The video was reviewed and annotated by two independent surgical oncologists to identify key technical steps and potential pitfalls.
5 Ethical Statement
This study was approved by the Ethics Committee of the First Affiliated Hospital of Xi‘an JiaoTong University (Approval No. 20230925). The patient provided written informed consent for surgery and the use of anonymized video footage for research and educational purposes.
Methods Video
RESULTS
The video successfully demonstrated the key steps of laparoscopic gastric tumor resection with a focus on omental bursa entry and gastroepiploic vessel preservation. The greater omentum was divided along the lateral side of the gastroepiploic arcade without injuring the arcade. An avascular window in the gastrocolic ligament was created, and entry into the omental bursa was confirmed by visualizing the posterior gastric wall and the anterior pancreatic surface. The gastroepiploic vascular arcade remained intact throughout the procedure. The greater curvature was mobilized adequately, and the tumor was clearly exposed. No intraoperative complications such as bleeding, transverse mesocolon injury, or gastric wall perforation occurred. The operative time for the mobilization phase was 35 minutes, and total operative time was 90 minutes. Estimated blood loss was 20 mL.
The multi‑perspective recording clearly illustrated the anatomical relationships between the stomach, greater omentum, gastrocolic ligament, and transverse mesocolon. The first‑person perspective provided an intuitive view of the surgeon‘s instrument handling, while the microscopic close‑up allowed clear visualization of the avascular plane.
Discussion
This study focuses on the initial and fundamental steps of laparoscopic gastric tumor resection—entry into the omental bursa and preservation of the gastroepiploic vessels. Through multi‑perspective video analysis, we have systematically demonstrated the key anatomical landmarks and technical maneuvers required for safe and effective completion of these steps.
1 Importance of correct omental bursa entry
The omental bursa is the gateway to the retrogastric space. Correct entry into the omental bursa allows the surgeon to mobilize the posterior gastric wall, expose tumors located on the posterior surface, and subsequently perform lymphadenectomy in radical gastrectomy. In contrast, incorrect entry—particularly entering the transverse mesocolon—can lead to bleeding, hematoma, or injury to the middle colic vessels. The avascular area of the gastrocolic ligament, located between the gastric wall and the transverse colon, is the safest entry point. Our video confirms that creating a window in this avascular zone and then gently expanding the opening with blunt dissection provides a clear and safe entry.
2 Preservation of the gastroepiploic vascular arcade
The gastroepiploic vessels are the main blood supply to the greater curvature of the stomach. In wedge resections or partial gastrectomies, preserving these vessels is critical for maintaining the viability of the remnant stomach. In total gastrectomy, while the entire stomach is removed, careful dissection along the arcade prevents unnecessary bleeding and keeps the operative field clean. Our video demonstrated that dividing the greater omentum lateral to the arcade, rather than directly on the arcade, reliably preserves the vessels. This technique is consistent with the principles of “vessel‑sparing” surgery recommended in the Japanese Gastric Cancer Treatment Guidelines.
3 Learning curve and training implications
Even basic steps such as omental bursa entry have a learning curve. A multicenter study by Brenkman et al. found that the overall complication rate of laparoscopic gastrectomy reached a plateau after 20 cases, with early complications often related to incorrect tissue plane identification. Our multi‑perspective video, including first‑person and microscopic close‑up views, is specifically designed to shorten this learning curve by providing trainees with a clear visual understanding of the correct anatomical planes.
4 Limitations
This study has limitations, including a single case and single‑center design. The findings may not be generalizable to all tumor locations or patient body habits. Future studies should include more cases with varying tumor locations and patient characteristics.
Conclusion
This study confirms that proper entry into the omental bursa through the avascular area of the gastrocolic ligament, combined with division of the greater omentum lateral to the gastroepiploic arcade, is a safe and reproducible technique for laparoscopic gastric tumor resection. These fundamental steps provide adequate tumor exposure and preserve the vascular arcade, minimizing intraoperative bleeding and preventing injury to adjacent structures. The multi‑perspective video analysis offers an effective educational tool for surgical trainees.
Author Contributions
Gang Xu wrote the first draft. Ruixiang Tang and Hao Zhang contributed to the critical revision of the manuscript. Yong Zhang reviewed and revised the manuscript. All authors have read and agreed to the published version of the manuscript.
Funding
None.
Conflicts of Interest
The authors declare no conflict of interest.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Received: 22 October 2025
Accepted: 20 November 2025
Published on line: 13 January 2026
Reference
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