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Endoscopy 2016; 48(11): 1010-1015
DOI: 10.1055/s-0042-111000
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Laparoscopy-assisted endoscopic full-thickness resection of gastric subepithelial tumors using a nonexposure technique

Osamu Goto
1   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
,
Hiroya Takeuchi
2   Department of Surgery, Keio University School of Medicine, Tokyo, Japan
,
Motoki Sasaki
1   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
,
Hirofumi Kawakubo
2   Department of Surgery, Keio University School of Medicine, Tokyo, Japan
,
Teppei Akimoto
1   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
,
Ai Fujimoto
1   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
,
Yasutoshi Ochiai
1   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
,
Tadateru Maehata
1   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
,
Toshihiro Nishizawa
1   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
,
Yuko Kitagawa
2   Department of Surgery, Keio University School of Medicine, Tokyo, Japan
,
Naohisa Yahagi
1   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

submitted 09 February 2016

accepted after revision 06 June 2016

Publication Date:
22 July 2016 (online)

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Video Comment on Goto et al.Endoscopy 2016; 48(11): v29-v29
DOI: 10.1055/s-0042-116908

Background and study aims: To avoid bacterial contamination and tumor seeding during gastrectomy surgery, we developed a nonexposure technique for endoscopic full-thickness resection with laparoscopic assistance. The feasibility and safety of nonexposed endoscopic wall-inversion surgery (NEWS) for gastric subepithelial tumors (SETs) were investigated.

Patients and methods: For protruding gastric SETs ≤ 3 cm in diameter, NEWS was performed in the following sequence: laparoscopic seromuscular incision after endoscopic submucosal injection, laparoscopic seromuscular suturing with the lesion inverted, endoscopic mucosal and submucosal incision, and transoral retrieval. Technical outcomes and postoperative courses were investigated.

Results: In all 20 consecutive cases, including six SETs with ulceration, NEWS was completed (mean procedural time, 213.5 minutes) without severe intraoperative or postoperative adverse events. R0 resection and perforation rates were 100 % and 5.0 %, respectively. During the mean observational period of 10.1 months, all patients survived without recurrence or apparent discomfort during food intake.

Conclusion: NEWS for gastric SETs was feasible and safe and represents a useful option for minimally invasive local resection even in cases of SETs with ulceration or cancers.

 

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