Endoscopic omental harvest.

An omental flap is useful in reconstructive surgery, but harvesting such a flap generally requires laparotomy. However, endoscopic surgery facilitates harvesting an omental flap without open laparotomy. We performed endoscopic omental harvest in two patients. We described the procedure of endoscopic omental harvest, which is different from that reported previously. Four access ports were required: two placed lateral to the right rectus margin, one placed lateral to the left rectus margin, and one placed in the infraumbilical area. The stomach was suspended from the peritoneum for the dissection of the gastric rami. The vessels from the gastroepiploic arcade to the greater curvature of the stomach were individually clipped and divided. The omentum then was dissected to the transverse colon and the lower portion of the omentum was dissected along the transverse colon. Finally, the right side of the omentum was dissected. The omentum was transferred using the right gastroepiploic vessels for anastomosis. The advantages of endoscopic harvest are an inconspicuous scar, minimal operative pain, and early recovery. The disadvantages include a long procedure time. At the present time, endoscopic harvest of the left side of the omentum is problematic because of difficulty in identifying the left omental artery and the risk of injury to the spleen. However, these limitations will likely be resolved in the future.