Seong-Ho Kong1,2, Michele Diana3,4, Yu-Yin Liu5,6, Hyun-Jik Lee1, Andras Legner1, Renato Soares1, Lee Swanström1, Bernard Dallemagne5, Han-Kwang Yang2, Jacques Marescaux1,5. 1. Image-Guided Minimally Invasive Surgical Institute, IHU-Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France. 2. Department of Surgery, Seoul National University Hospital, Seoul, South Korea. 3. Image-Guided Minimally Invasive Surgical Institute, IHU-Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France. michele.diana@ircad.fr. 4. Research Institute Against Cancer of the Digestive System (IRCAD), Strasbourg, France. michele.diana@ircad.fr. 5. Research Institute Against Cancer of the Digestive System (IRCAD), Strasbourg, France. 6. Department of General Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan.
Abstract
BACKGROUND: Current surgical methods for partial gastric full-thickness resections (FTRs) are limited by long operative times and risk of gastric content spillage, especially for lesions located at the posterior wall. We propose a simplified hybrid approach to FTR with reduced risk of spillage. METHODS: Resection margins were marked by endoscopic electrocautery to simulate a gastric lesion in the upper third of the posterior wall in eight pigs. A custom-made laparoscopic "suture passer" was made of a sharpened bendable dissecting forceps. Full-thickness sutures were alternatively passed from the serosa side with the suture passer through the gastric wall and grabbed endoluminally using an endoscopic grasper and vice versa. These transgastric sutures formed either a purse string (PS; n = 4) or a continuous horizontal mattress (HM; n = 4). Sutures were then fastened from the laparoscopic side, resulting in external outpouching of the lesion. The pouch was transected using 45-mm linear staplers. Operative time, resection margins, and number of staplers were evaluated. RESULTS: The combined approach allowed one to precisely place the sutures around the pseudo lesions, despite the inflated stomach, and it included all target markings. PS and HM methods were similar regarding time for transgastric suture (780 s ± 219.1 s vs. 765 s ± 179.2 s, p = .885), resection margins (1.3 ± 1.0 cm vs. 0.8 ± 0.6 cm, p = .248), and number of staplers (3.8 ± 1.0 vs 3.3 ± 0.5, p = .405). Stapling time (600 s ± 189.7 s vs. 330 s ± 24.5 s, p = .028) was significantly shorter in the HM technique. CONCLUSION: FTR with laparo-endoscopic transgastric suture application was feasible in the animal model. This technique allows one to achieve accurate resection margins with minimal risk of spillage.
BACKGROUND: Current surgical methods for partial gastric full-thickness resections (FTRs) are limited by long operative times and risk of gastric content spillage, especially for lesions located at the posterior wall. We propose a simplified hybrid approach to FTR with reduced risk of spillage. METHODS: Resection margins were marked by endoscopic electrocautery to simulate a gastric lesion in the upper third of the posterior wall in eight pigs. A custom-made laparoscopic "suture passer" was made of a sharpened bendable dissecting forceps. Full-thickness sutures were alternatively passed from the serosa side with the suture passer through the gastric wall and grabbed endoluminally using an endoscopic grasper and vice versa. These transgastric sutures formed either a purse string (PS; n = 4) or a continuous horizontal mattress (HM; n = 4). Sutures were then fastened from the laparoscopic side, resulting in external outpouching of the lesion. The pouch was transected using 45-mm linear staplers. Operative time, resection margins, and number of staplers were evaluated. RESULTS: The combined approach allowed one to precisely place the sutures around the pseudo lesions, despite the inflated stomach, and it included all target markings. PS and HM methods were similar regarding time for transgastric suture (780 s ± 219.1 s vs. 765 s ± 179.2 s, p = .885), resection margins (1.3 ± 1.0 cm vs. 0.8 ± 0.6 cm, p = .248), and number of staplers (3.8 ± 1.0 vs 3.3 ± 0.5, p = .405). Stapling time (600 s ± 189.7 s vs. 330 s ± 24.5 s, p = .028) was significantly shorter in the HM technique. CONCLUSION: FTR with laparo-endoscopic transgastric suture application was feasible in the animal model. This technique allows one to achieve accurate resection margins with minimal risk of spillage.
Entities:
Keywords:
Full-thickness resection; Gastric cancer; Hybrid laparo-endoscopic surgery
Authors: Vimal K Narula; Jeffrey W Hazey; David B Renton; Kevin M Reavis; Christopher M Paul; Kristen E Hinshaw; Bradley J Needleman; Dean J Mikami; E Christopher Ellison; W Scott Melvin Journal: Surg Endosc Date: 2007-11-20 Impact factor: 4.584