Noble method for intraoperative tumor localization during laparoscopic local resection of stomach: endoscopic submucosal cutting and light transmission

Young-Joon Lee, Ji-Ho Park, Sang-Ho Jeong, Chang Yoon Ha, Ju-Yeon Kim, Taejin Park, Chi-Young Jeong, Young-tae Ju, Eun-Jung Jung, Soon-Chan Hong, Sang-Kyung Choi, Woo-Song Ha. Gyeongsang National University.

Backgrouds: Intraoperative tumor localization is prerequisite for deciding the proper extent of gastric resection during laparoscopic gastric local resection of early mucosal cancer and submucosal tumor. In this study, we introduce a novel method for precise intraoperative tumor localization and appropriate resection in porcine model: endoscopic submucosal cutting and light transmission.

Methods: A series of 4 pigs (32 – 34 kg) were used for this study approved by an animal use committee. Total 10 cases of laparoscopic local resection were performed. The size of the target lesion was approximately 20 mm. The imaginary lesions were located in high body anterior wall (n = 2) and posterior wall (n =2), lower body posterior wall (n = 2), angle (n =2), and antrum anterior wall (n = 2) of the stomach. We sequentially performed mucosal marking around the lesion, precutting the mucosa surrounding the marking, and submucosal cutting along the precutting line using white light endoscopy (A). Then, endoscopic light source was directly placed in front of the lesion (B). We could identify exact oval shaped submucosal cutting margin in laparoscopic view (C). The laparoscopic local resection was done under direct endoscopic view after confirming minimal distance from the stapler line to submucosal cutting line (D). After extracting of the resected specimen, we removed linear stapler line and measured the size of mucosal marking, submucosal cutting, resected entire mucosa, and resected entire serosa.

Results: The procedure was completed for all the pigs. The local resection of stomach was completed for the all lesion. We could identify the exact submucosal cutting line of the resected specimen in all cases. The mean size of the resected specimen are: (i) marking lesion, 22 Χ 19.5 mm; (ii) submucosal cutting, 26.7 Χ 23.2 mm; (iii) resected entire mucosa, 37 Χ 31 mm; and (iv) resected entire serosa, 41.7 Χ 33.1 mm, respectively. There was no intraoperative morbidity.

Conclusion: Endoscopic submucosal cutting and light transmission provides an exact and useful method of intraoperative tumor localization during laparoscopic local resection of stomach in terms of minimal resection of normal stomach tissue and surefire guarantee of mucosal margin.



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