M Patrzyk1, K Ludwig, C D Heidecke, W von Bernstorff, A Glitsch. 1. Department of Surgery, Clinic of General Surgery, Visceral, Thoracic and Vascular Surgery, Ernst-Moritz-Arndt-University Hospital, Friedrich-Loeffler-Str. 23b, 17489, Greifswald, Germany. patrzyk@uni-greifswald.de
Abstract
BACKGROUND: Locating gastrointestinal stromal tumors (GIST) during laparoscopic surgery continues sometimes to be difficult and inaccurate. In addition, the methods used for tumor mapping often do not lead to precise location of tumors. Also, they are too expensive or too complex for an easy surgical approach. Furthermore, the standard wedge resection often sacrifices too much healthy tissue. METHODS: The current study introduces an innovative tissue-sparing method using laser-supported diaphanoscopy (Endolight) for exact location of GIST during laparoscopic surgery. The instrument was developed by the authors' group. This study retrospectively evaluated two groups of patients experiencing GIST. The first group of 10 patients was treated by standard wedge resection. The second group of 10 patients was treated by Endolight-guided laparoscopic resection during a laparoscopic-endoscopic rendezvous procedure. RESULTS: After precise location of GIST using Endolight, all patients could be successfully resected. The largest resection margins using Endolight (9.8±3.8 mm) were significantly smaller than the largest resection margins using wedge resection (stapler) without Endolight (21.5±9.1 mm; p<0.0001). The average surgery time for the group treated by standard wedge resection was 65 min (range, 28-108 min). The surgery time required for the group treated by Endolight-guided resections ranged from 48 to 189 min (average, 123 min). The number of marks used for Endolight resections ranged from four to seven depending on the location and size of the tumor. CONCLUSION: The reported technique allows the precise location of GIST, leading to exact and tissue-sparing transmural laparoscopic resection of these tumors compared with standard wedge-resection. Laser-supported diaphanoscopy using the newly developed innovative device offers new perspectives and a highly effective technique for resecting GIST that combines an endoscopic with a laparoscopic approach.
BACKGROUND: Locating gastrointestinal stromal tumors (GIST) during laparoscopic surgery continues sometimes to be difficult and inaccurate. In addition, the methods used for tumor mapping often do not lead to precise location of tumors. Also, they are too expensive or too complex for an easy surgical approach. Furthermore, the standard wedge resection often sacrifices too much healthy tissue. METHODS: The current study introduces an innovative tissue-sparing method using laser-supported diaphanoscopy (Endolight) for exact location of GIST during laparoscopic surgery. The instrument was developed by the authors' group. This study retrospectively evaluated two groups of patients experiencing GIST. The first group of 10 patients was treated by standard wedge resection. The second group of 10 patients was treated by Endolight-guided laparoscopic resection during a laparoscopic-endoscopic rendezvous procedure. RESULTS: After precise location of GIST using Endolight, all patients could be successfully resected. The largest resection margins using Endolight (9.8±3.8 mm) were significantly smaller than the largest resection margins using wedge resection (stapler) without Endolight (21.5±9.1 mm; p<0.0001). The average surgery time for the group treated by standard wedge resection was 65 min (range, 28-108 min). The surgery time required for the group treated by Endolight-guided resections ranged from 48 to 189 min (average, 123 min). The number of marks used for Endolight resections ranged from four to seven depending on the location and size of the tumor. CONCLUSION: The reported technique allows the precise location of GIST, leading to exact and tissue-sparing transmural laparoscopic resection of these tumors compared with standard wedge-resection. Laser-supported diaphanoscopy using the newly developed innovative device offers new perspectives and a highly effective technique for resecting GIST that combines an endoscopic with a laparoscopic approach.