Dan Eisenberg1, Robert Bell. 1. Stanford School of Medicine and Palo Alto VA Health Care System, Palo Alto, California 94304, USA. de1@stanford.edu
Abstract
BACKGROUND: Laparoscopy is increasingly becoming a preferred approach to surgery of the gastrointestinal tract. Proper localization of small benign tumors is essential for precise non-anatomical excisions and remains difficult with the laparoscopic approach due to the greatly diminished tactile feedback. METHODS: Between July 2006 and June 2007, 4 patients underwent resection of benign small gastrointestinal lesions. All resections were performed laparoscopically, with intraoperative endoscopy, using picture-in-picture display of both views on a single monitor. RESULTS: All 4 cases were completed laparoscopically. Three involved gastric lesions and 1 involved a cecal lesion. Adequacy of resection was confirmed grossly by real-time intraoperative endoscopy and microscopically by histology. Gastric lesions included pancreatic heterotopia, a gastrointestinal stromal tumor, and a Dieulafoy's lesion. The cecal lesion was a granular cell tumor. Operative times ranged from 57 min to 110 min (mean 91 min), and the average postoperative length of hospital stay was 3.5 d. CONCLUSION: Real-time intraoperative endoscopy with picture-in-picture viewing is a powerful surgical tool allowing for simultaneous intra- and extra-luminal views. Thus, endoscopic guidance allows for even the most subtle lesions to be identified and precisely excised. In addition, the adequacy of the laparoscopic procedure can be evaluated in real time, allowing for immediate adjustments or revisions to be made when needed. The endoscopic view allows for hemostasis to be ensured, and for precise anatomical excisions to be performed, especially in cases requiring the preservation of the pylorus or ileocecal valve. Larger series are needed to further establish the efficacy of this surgical approach.
BACKGROUND: Laparoscopy is increasingly becoming a preferred approach to surgery of the gastrointestinal tract. Proper localization of small benign tumors is essential for precise non-anatomical excisions and remains difficult with the laparoscopic approach due to the greatly diminished tactile feedback. METHODS: Between July 2006 and June 2007, 4 patients underwent resection of benign small gastrointestinal lesions. All resections were performed laparoscopically, with intraoperative endoscopy, using picture-in-picture display of both views on a single monitor. RESULTS: All 4 cases were completed laparoscopically. Three involved gastric lesions and 1 involved a cecal lesion. Adequacy of resection was confirmed grossly by real-time intraoperative endoscopy and microscopically by histology. Gastric lesions included pancreatic heterotopia, a gastrointestinal stromal tumor, and a Dieulafoy's lesion. The cecal lesion was a granular cell tumor. Operative times ranged from 57 min to 110 min (mean 91 min), and the average postoperative length of hospital stay was 3.5 d. CONCLUSION: Real-time intraoperative endoscopy with picture-in-picture viewing is a powerful surgical tool allowing for simultaneous intra- and extra-luminal views. Thus, endoscopic guidance allows for even the most subtle lesions to be identified and precisely excised. In addition, the adequacy of the laparoscopic procedure can be evaluated in real time, allowing for immediate adjustments or revisions to be made when needed. The endoscopic view allows for hemostasis to be ensured, and for precise anatomical excisions to be performed, especially in cases requiring the preservation of the pylorus or ileocecal valve. Larger series are needed to further establish the efficacy of this surgical approach.