Laparoscopic Intragastric Surgery Research Articles

Laparoscopic Intragastric Surgery Revisited

When the gastric submucosal tumor (SMT) locates adjacent to the esophagogastric junction (EGJ), it is difficult to preserve EGJ technically and oncologically. In this study, we describe our clinical experience with laparoscopic intragastric surgery (LIGS) and discuss its role for gastric SMTs adjacent to EGJ. A retrospective review was performed on patients who underwent surgical treatment of gastric SMTs adjacent to EGJ (April 1994 to May 2010). They were divided into 3 groups: laparoscopic partial gastrectomy (LAP, n=10), LIGS (n=10), and open laparotomy (OPEN, n=7), respectively. The completion rates were 50% in LAP and 90% in LIGS. Overall preservation rate of EGJ was 80% (LAP), 100% (LIGS), and 29% (OPEN), respectively. The patients who underwent total/proximal mastectomy showed significantly higher incidence of postoperative gastrointestinal symptoms, which required long-term medication. LIGS stays as a valuable alternative and would be an attractive option for gastric SMTs adjacent to EGJ.

Single-Port Laparoscopic Intragastric Surgery Using SILS Port

The aim of this study was to evaluate the feasibility, safety, and efficiency of single-port laparoscopic intragastric surgery by using a single-port device. The single-port device was introduced into the anterior wall of the stomach through 2.5-cm long abdominal and gastric incisions. Gastric mucosa resection and suturing (group 1) and mucosa resection by using staplers (group 2) were performed with 3 pigs in each group. The time for setting up the intragastric ports ranged from 8 to 40 minutes (average 16.2 ± 12.2 minutes). The total surgery times for the 3 pigs in group 1 were 75, 45, and 38 minutes and for the other 3 pigs in group 2 were 80, 85, 70 minutes, respectively. A simple and stable intragastric surgery platform can be set up by using the single-port device placed into the stomach. This seems to be safe and feasible and may be a suitable alternative for humans.

Laparoscopic Intragastric Surgery Under Carbon Dioxide Pneumostomach

Laparoscopic intragastric surgery (LIGS) requires a "pneumostomach," which is created by air insufflation via gastroscopy. If the procedure is done without duodenal clamping, migrated air from the stomach causes excessive, prolonged bowel distention, which may lead to drawbacks during and after the operation. Carbon dioxide (CO(2)), with its faster absorption than air, can attenuate bowel distention when used to establish the pneumostomach. The aims of this study were to evaluate feasibility, safety, and effectiveness of the CO(2) pneumostomach in LIGS. We have performed 15 LIGSs under the CO(2) pneumostomach (January 1997 to August 2004). The stomach was insufflated with CO(2) through an automatic surgical insufflator up to 8 mm Hg of intraluminal pressure. Neither a duodenal clamp nor an occlusion was employed prior to insufflation. Cardiopulmonary parameters were prospectively registered and retrospectively analyzed. The degree and extent of bowel distention was assessed by a concluding laparoscopy, and the amount of intestinal gas was evaluated by a postoperative plain abdominal radiograph. LIGS was completed in all 15 cases, with a mean intragastric insufflation time of 100 minutes. The CO(2) pneumostomach provided good, constant surgical exposure with sufficient working space. No adverse impact of intragastric CO(2) insufflation was observed on the cardiopulmonary function. Even without duodenal clamping, the insufflated small bowel loops already shrank at the time of the concluding laparoscopy. Fair residual gas was documented radiologically in 2 cases, whereas it was only faint in the remaining 13 cases. No patients showed abdominal pain or bloating postoperatively. The CO(2) pneumostomach is a feasible, safe alternative and is potentially effective for LIGS by eliminating the need for prior duodenal clamping and by minimizing bowel distention.

Laparoscopic Intragastric Surgery Using GelPort

In laparoscopic intragastric surgery for early gastric cancer and submucosal tumors, three trocars are routinely inserted in the gastric lumen. We placed a GelPort hand assist device through a 5-cm transverse incision in the upper abdomen, and inserted the trocars into the gastric lumen through the gel seal cap, snapping the gel seal cap on and off during the operation. This makes it possible to use an open technique in which trocars are inserted into the gastric lumen, and to close the trocar sites in the gastric wall. We believe that the technique described here is easier and saves time compared with inserting trocars and closing trocar sites laparoscopically.

GASTRIC LIPOMA SUCCESSFULLY REMOVED BY LAPAROSCOPIC INTRAGASTRIC SURGERY

Lipomas are found very rarely in the stomach, where they account for only 3% of benign gastric tumors. Here, we report a case of large gastric lipoma removed successfully by laparoscopic intragastric surgery. A 45‐year‐old woman with no symptoms was incidentally diagnosed with a yellowish submucosal gastric tumor, about 3 cm in diameter, in the prepyloric antrum by upper gastrointestinal endoscopy. Pathological findings of biopsy specimens showed no evidence of malignancy. Computed tomography showed an ovoid and well‐circumscribed intramural mass, measuring 35 mm, which was of fat density. These findings suggested that the tumor was a lipoma that we felt should be treated, because large lipomas can give rise to gastrointestinal bleeding. We performed a laparoscopic intragastric enucleation for this tumor. Postoperatively, the tumor was confirmed pathologically to be a lipoma of the stomach. This laparoscopic procedure for benign non‐epithelial gastric tumors, such as lipomas, presented here is technically feasible, safe, and less stressful for the patient than gastrectomy.

Laparoscopic intragastric resection of gastric stromal tumor located at the esophago-cardiac junction.

We performed laparoscopic intragastric surgery (LIGS) for gastric stromal tumors located at the esophago-cardiac junction (ECJ) in 7 patients. The tumors measured 27 to 75 mm in diameters. Histologically, there were 4 cases of gastrointestinal stromal tumors, 2 leiomyomas, and 1 schwannoma. LIGS was performed with 1 camera port (10 mm) inserted by the open method and two 5-mm working ports inserted by puncturing the stomach. Tumors were enucleated or resected with appropriate margins confirming the muscle layer of the stomach wall and retrieved orally by gastrofiberscope. The mean surgical duration was 141.4 minutes. Recent patients took their first meal on day 3 postoperatively and were discharged within a week. There were no complications including stenosis or gastroesophageal reflux in any patient to date. LIGS is a feasible surgical option for gastric stromal tumors located at ECJ.

Laparoscopic intragastric surgery using a radially expandable sleeve.

Laparoscopic intragastric surgery (LIGS) has become more widely established in Japan as a therapy for early gastric cancers and some types of submucosal gastric tumors. However, there have been some technical difficulties with the original method of LIGS. Certain complicated procedures to access the gastric lumen are required, along with repair of the gastric wall after endoluminal procedures. Using a 5-mm radially expandable sleeve (RES) for the working ports in LIGS, it becomes easier to establish access to the gastric lumen, and repair of the port sites on the gastric wall is not required. Using RES makes LIGS a simpler, less invasive procedure.

早期胃癌に対する腹腔鏡下胃内手術 その適応と手技ならびに臨床成績について

早期胃癌に対する腹腔鏡下手術の1つとして, われわれが開発した腹腔鏡下胃内手術の手技と最近4年間の成績を報告し, その適応と術式の工夫などについても考察した.対象は早期胃癌21例 (m癌15例, sm癌6例) で, 男17例・女4例, 平均年齢は71.4歳である.適応は当初高齢者ならびに開腹術拒否者の早期癌としていたが, 最近では次第に適応を拡大しつつある.術中トラブルで2例開腹移行したが, 重篤な術後合併症はみられなかった.m癌症例では全例とも再発を認めていない.sm癌症例2例に局所再発を認めたが, これらは開腹術拒否者と高齢者であり, 内視鏡的レーザー焼灼にて経過観察中である.本法の最も良い適応は, 内視鏡的粘膜切除術 (EMR) が技術的に困難な高分化型のm癌であるが, 高齢者など大きな侵襲を避けたい症例では, sm浸潤の疑われる症例でも適応になると考えている.今後, 本法は早期胃癌に対する治療選択の1つとして, 有用な術式になると期待される.

Laparoscopic intraluminal (intragastric) surgery for early gastric cancer. A new concept in laparoscopic surgery.

A new laparoscopic operation for the treatment of mucosal or submucosal gastric lesions has been designed and performed on eight patients. In this procedure, all three trocars are placed in the gastric lumen, penetrating both the abdominal and stomach walls in order to perform a laparoscopic removal of gastric lesions. The operation is then carried out in the gastric lumen with currently available laparoscopic instruments and laparoscopic monitoring. The procedure is easy, safe, and feasible for mucosal or submucosal lesions of the stomach which cannot be treated by gastrofiberscopic technique. In this series, 6 patients with early gastric cancer, 1 with a submucosal leiomyoma, and 1 with giant polyp of the stomach were treated without complications. Since this technique is based on a new concept in laparoscopic surgery, the author has named this intraluminal operation "laparoscopic intragastric surgery."