Skip to main content
SpringerLink
Log in

Novel method for hybrid endo-laparoscopic full-thickness gastric resection using laparoscopic transgastric suture passer device

  • Dynamic Manuscript
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Hamashima C, Ogoshi K, Okamoto M, Shabana M, Kishimoto T, Fukao A (2013) A community-based, case-control study evaluating mortality reduction from gastric cancer by endoscopic screening in Japan. PLoS ONE 8(11):e79088. doi:10.1371/journal.pone.0079088

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kim YG, Kong SH, Oh SY, Lee KG, Suh YS, Yang JY, Choi J, Kim SG, Kim JS, Kim WH, Lee HJ, Yang HK (2014) Effects of screening on gastric cancer management: comparative analysis of the results in 2006 and in 2011. J Gastric Cancer 14(2):129–134. doi:10.5230/jgc.2014.14.2.129

    Article  PubMed  PubMed Central  Google Scholar 

  3. Gotoda T, Kusano C, Moriyasu F (2014) Future perspective of gastric cancer endotherapy. Ann Transl Med 2(3):25. doi:10.3978/j.issn.2305-5839.2014.03.03

    PubMed  PubMed Central  Google Scholar 

  4. Kong SH, Yoo MW, Kim JW, Lee HJ, Kim WH, Lee KU, Yang HK (2011) Validation of limited lymphadenectomy for lower-third gastric cancer based on depth of tumour invasion. Br J Surg 98(1):65–72. doi:10.1002/bjs.7266

    Article  PubMed  Google Scholar 

  5. Schlag C, Wilhelm D, von Delius S, Feussner H, Meining A (2013) EndoResect study: endoscopic full-thickness resection of gastric subepithelial tumors. Endoscopy 45(1):4–11. doi:10.1055/s-0032-1325760

    CAS  PubMed  Google Scholar 

  6. Asakuma M, Cahill RA, Lee SW, Nomura E, Tanigawa N (2010) NOTES: the question for minimal resection and sentinel node in early gastric cancer. World J Gastrointest Surg 2(6):203–206. doi:10.4240/wjgs.v2.i6.203

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hiki N, Nunobe S, Matsuda T, Hirasawa T, Yamamoto Y, Yamaguchi T (2014) Laparoscopic endoscopic cooperative surgery (LECS). Dig Endosc. doi:10.1111/den.12404

    Google Scholar 

  8. Fujimura T, Fushida S, Tsukada T, Kinoshita J, Oyama K, Miyashita T, Takamura H, Kinami S, Ohta T (2014) A new stage of sentinel node navigation surgery in early gastric cancer. Gastric Cancer. doi:10.1007/s10120-014-0446-z

    Google Scholar 

  9. Hiki N, Yamamoto Y, Fukunaga T, Yamaguchi T, Nunobe S, Tokunaga M, Miki A, Ohyama S, Seto Y (2008) Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection. Surgical endoscopy 22(7):1729–1735. doi:10.1007/s00464-007-9696-8

    Article  CAS  PubMed  Google Scholar 

  10. Abe N, Takeuchi H, Yanagida O, Masaki T, Mori T, Sugiyama M, Atomi Y (2009) Endoscopic full-thickness resection with laparoscopic assistance as hybrid NOTES for gastric submucosal tumor. Surg Endosc 23(8):1908–1913. doi:10.1007/s00464-008-0317-y

    Article  PubMed  Google Scholar 

  11. Kong SH, Yang HK (2013) Surgical treatment of gastric gastrointestinal stromal tumor. J Gastric Cancer 13(1):3–18. doi:10.5230/jgc.2013.13.1.3

    Article  PubMed  PubMed Central  Google Scholar 

  12. Narula VK, Hazey JW, Renton DB, Reavis KM, Paul CM, Hinshaw KE, Needleman BJ, Mikami DJ, Ellison EC, Melvin WS (2008) Transgastric instrumentation and bacterial contamination of the peritoneal cavity. Surg Endosc 22(3):605–611. doi:10.1007/s00464-007-9661-6

    Article  PubMed  Google Scholar 

  13. Han TS, Kong SH, Lee HJ, Ahn HS, Hur K, Yu J, Kim WH, Yang HK (2011) Dissemination of free cancer cells from the gastric lumen and from perigastric lymphovascular pedicles during radical gastric cancer surgery. Ann Surg Oncol 18(10):2818–2825. doi:10.1245/s10434-011-1620-8

    Article  PubMed  Google Scholar 

  14. Nunobe S, Hiki N, Gotoda T, Murao T, Haruma K, Matsumoto H, Hirai T, Tanimura S, Sano T, Yamaguchi T (2012) Successful application of laparoscopic and endoscopic cooperative surgery (LECS) for a lateral-spreading mucosal gastric cancer. Gastric Cancer 15(3):338–342. doi:10.1007/s10120-012-0146-5

    Article  PubMed  Google Scholar 

  15. Inoue H, Ikeda H, Hosoya T, Yoshida A, Onimaru M, Suzuki M, Kudo SE (2012) Endoscopic mucosal resection, endoscopic submucosal dissection, and beyond: full-layer resection for gastric cancer with nonexposure technique (CLEAN-NET). Surg Oncol Clin N Am 21(1):129–140. doi:10.1016/j.soc.2011.09.012

    Article  PubMed  Google Scholar 

  16. Mitsui T, Goto O, Shimizu N, Hatao F, Wada I, Niimi K, Asada-Hirayama I, Fujishiro M, Koike K, Seto Y (2013) Novel technique for full-thickness resection of gastric malignancy: feasibility of nonexposed endoscopic wall-inversion surgery (news) in porcine models. Surg Laparosc Endosc Percutan Tech 23(6):e217–e221. doi:10.1097/SLE.0b013e31828e3f94

    Article  PubMed  Google Scholar 

  17. Goto O, Takeuchi H, Kawakubo H, Matsuda S, Kato F, Sasaki M, Fujimoto A, Ochiai Y, Horii J, Uraoka T, Kitagawa Y, Yahagi N (2014) Feasibility of non-exposed endoscopic wall-inversion surgery with sentinel node basin dissection as a new surgical method for early gastric cancer: a porcine survival study. Gastric Cancer. doi:10.1007/s10120-014-0358-y

    Google Scholar 

  18. Mitsui T, Niimi K, Yamashita H, Goto O, Aikou S, Hatao F, Wada I, Shimizu N, Fujishiro M, Koike K, Seto Y (2014) Non-exposed endoscopic wall-inversion surgery as a novel partial gastrectomy technique. Gastric Cancer 17(3):594–599. doi:10.1007/s10120-013-0291-5

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ikehara H, Gotoda T, Ono H, Oda I, Saito D (2007) Gastric perforation during endoscopic resection for gastric carcinoma and the risk of peritoneal dissemination. Br J Surg 94(8):992–995. doi:10.1002/bjs.5636

    Article  CAS  PubMed  Google Scholar 

  20. Miwa K, Kinami S, Taniguchi K, Fushida S, Fujimura T, Nonomura A (2003) Mapping sentinel nodes in patients with early-stage gastric carcinoma. Br J Surg 90(2):178–182. doi:10.1002/bjs.4031

    Article  CAS  PubMed  Google Scholar 

  21. Kitagawa Y, Takeuchi H, Takagi Y, Natsugoe S, Terashima M, Murakami N, Fujimura T, Tsujimoto H, Hayashi H, Yoshimizu N, Takagane A, Mohri Y, Nabeshima K, Uenosono Y, Kinami S, Sakamoto J, Morita S, Aikou T, Miwa K, Kitajima M (2013) Sentinel node mapping for gastric cancer: a prospective multicenter trial in Japan. J Clin Oncol 31(29):3704–3710. doi:10.1200/JCO.2013.50.3789

    Article  PubMed  Google Scholar 

  22. Lee JH, Lee MS, Kim HH, Park DJ, Lee KH, Hwang JY, Lee HJ, Yang HK, Lee KU (2011) Feasibility of laparoscopic partial gastrectomy with sentinel node basin dissection in a porcine model. Surg Endosc 25(4):1070–1075. doi:10.1007/s00464-010-1318-1

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Authors are grateful to Christopher Burel and to Guy Temporal, professionals in medical English proofreading, for their valuable help with manuscript drafting.

Disclosures

Seong-Ho Kong, Michele Diana, Yu-Yin Liu, Hyun-Jik Lee, Andras Legner, Renato Soares, Lee Swanström, Bernard Dallemagne, Han-Kwang Yang, and Jacques Marescaux have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Image-Guided Minimally Invasive Surgical Institute, IHU-Strasbourg, 1, place de l’Hôpital, 67091, Strasbourg Cedex, France

    Seong-Ho Kong, Michele Diana, Hyun-Jik Lee, Andras Legner, Renato Soares, Lee Swanström & Jacques Marescaux

  2. Research Institute Against Cancer of the Digestive System (IRCAD), Strasbourg, France

    Michele Diana, Yu-Yin Liu, Bernard Dallemagne & Jacques Marescaux

  3. Department of Surgery, Seoul National University Hospital, Seoul, South Korea

    Seong-Ho Kong & Han-Kwang Yang

  4. Department of General Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan

    Yu-Yin Liu

Authors
  1. Seong-Ho Kong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michele Diana
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yu-Yin Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hyun-Jik Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andras Legner
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Renato Soares
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lee Swanström
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Bernard Dallemagne
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Han-Kwang Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jacques Marescaux
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michele Diana.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (mov 19954 kb)

Supplementary material 2 (mov 19991 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kong, SH., Diana, M., Liu, YY. et al. Novel method for hybrid endo-laparoscopic full-thickness gastric resection using laparoscopic transgastric suture passer device. Surg Endosc 30, 1683–1691 (2016). https://doi.org/10.1007/s00464-015-4375-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4375-7

Keywords

Search

Navigation