Manual Suture Research Articles

The effect of three different surgical techniques for colon anastomosis on regional postoperative microperfusion: Laser Doppler Flowmetry study in pigs.

The optimal surgical approach to reconnecting bowel ends safely after resection is of great importance. This project is focused on assessment of the perianastomotic microcirculation quality in the short postoperative period when using three different anastomosis techniques in experimental animal. The experimental study involved 27 young female domestic pigs divided into three subgroups of 9 animals according to each surgical method of anastomosis construction in the sigmoid colon region: by manual suture, by stapler, or by gluing. Blood microcirculation in the anastomosis region was monitored using Laser Doppler Flowmetry (LDF). Anastomosis healing was evaluated by macroscopic and histological examination. Evaluation of the microcirculation in the anastomosis region showed the smallest decrease in perfusion values in animals reconstructed by suturing (Δ= -38.01%). A significantly more profound drop was observed postoperatively after stapling or gluing (Δ= -52.42% and Δ= -59.53%, respectively). All performed anastomoses healed without any signs of tissue and function pathology. Sewing, stapling, and gluing techniques for bowel anastomosis each have a different effect on regional microcirculation during 120 min. postoperatively. Nevertheless, the final results of anastomosis healing were found without of any pathology in all experimental animals managed by above mentioned anastomotic techniques.

Análisis de variables relacionadas con la morbimortalidad de la anastomosis ileocólica después de hemicolectomía derecha

Introduction: Right hemicolectomy with ileocolic anastomosis is a frequent surgery with many ways to perform it. Objective: To evaluate which is the best ileocolic anastomosis in terms of morbidity and mortality and to make a comparative evaluation of the postoperative clinical evolution according to the type of anastomosis. Patients and Method: Analytical observational study, with defined inclusion and exclusion criteria. The variables to be studied are divided into two groups, those related to the surgical technique and its anastomotic configuration, and the variables related to the results of the surgical intervention, creating a contingency table that crosses the data. Data analysis with STATA 13.0. Results: 216 patients with ileocolic anastomosis, highlighting statistical significance when crossing: A) reoperation and type of suture (p = 0.044), with UN or 3.4 (95% CI 0.94 to 18.6), being of greater risk the mechanics; B) mortality and urgency (p = 0.001) with an OR 7.76 (95% CI 1.56-49.29), with emergency surgery being of greater risk. Isoperistaltic anastomosis with gas elimination (p < 0.001), intestinal transit (p = 0.009) and solid intake (p = 0.005) earlier. There is earlier expulsion of gases in the laparoscopic approach, manual suture, end-to-side and isoperistaltic of the anastomosis and elective surgery. Conclusion: There is great variability of techniques to perform the ileocolic anastomosis. Manual anastomosis is less likely to require surgical reoperation, elective surgery has a lower mortality than that of emergency surgery. We suggest performing it laparoscopically, with manual suture, lateral term, isoperistaltic and electively, for having a shorter recovery.

TEACHING MODEL FOR EVALUATION OF THE ABILITY AND COMPETENCE PROGRESS IN ENDOSUTURE IN SURGICAL SKILL LABORATORY.

ABSTRACT Background : Laparoscopic manual suturing is probably the most difficult skill to be acquired in minimally invasive surgery. However, laparoscopic exercise endo-sutures can be learned with a simulator and are of great practical importance and clinical applicability, absorbing concepts that are immediately transferred to the operating room. Aim : To assess the progression of skills competence in endo-sutures through realistic simulation model of systematized education. Method : Evaluation of the progression of competence of students in three sequential stages of training in realistic simulation, pre-test (V.1), teaching concepts (V.2) and training station for absorption of video concepts in surgery - ergonomics, stereotaxia, ambidexterity, haptic touch, fucral effect, applied in the manufacture of points corresponding to a Nissen fundoplication, in endo-suture for realistic simulation. Results : All students who attended the course absorbed the video concepts in surgery; most participants showed steady and continued improvement and during the stages of training, obtained progression of appropriate skills, defining competence and validation of the teaching model to achieve proficiency. Conclusions : The teaching model was adequate, safe, revealed the profile of the student, the evolutionary powers of the endo-sutures performance and critical analysis of the training to achieve proficiency in bariatric procedures.

Experimental study on the resistance to intraluminal pressure between handsewn and stapled anastomosis. In vitro experimental study

We performed different types of stapled and manual sutures and the pressure level was measured using a differential pressure manometer. Although the hand-sewn end-to-end suture turned out to be the most resistant to pressure, statistical analysis revealed no significant differences compared to stapled suture (p = 0.49). In stump closure techniques, we observed a statistically high significance in resistance to pressure in the favour of manual stump closure (p = 0.004).Regarding side-to-side sutures we did not find any statistically significant differences in resistance to pressure between the techniques (p = 0.06). We can conclude that regarding the stump closure, the most resistant to pressure is the hand-sewn procedure, but in the other types of anastomosis, no significant differences was found between the stapled and hand-sewn techniques. Orv Hetil. 2017; 158(42): 1674-1680.

Biomechanical characterization of a novel ring connector for sutureless aortic anastomosis.

The surgical treatment for aortic diseases remains a challenge for any cardiac surgeon. The use of sutureless ring connector in aortic anastomosis can simplify the procedure and shorten anastomosis time. Therefore, we developed a novel device for sutureless aortic anastomosis. A series of experiments were carried out for tensile and leakproof-capacity assessments to verify the feasibility of the ring connector by using fresh swine aorta samples. In in vivo test, the ring connector was implanted in 6 swine with follow-up of 6 months. Radiographic and pathological studies of the aorta were performed. In the tensile tests, the strength was 32.7±5.9 Newton (N) in the sutureless anastomosis group, compared with 73.3±12.5 N in the control group by traditional manual suture. In the leakproof-capacity assessment, no sign of either leakage or bursting was evident at 280 mmHg of internal pressure in the aorta samples. In in vivo tests, it took 9.47±0.3 minutes for the sutureless anastomosis, compared with 15.58±1.39 minutes for hand-sewn suturing. Insertion was easy and rapid. Radiographic and pathological studies were performed at first month, third month and sixth month after surgery, each time obtained from the two swine, showed patency of the anastomosis and no signs of stenosis, blood leakage, migration or pseudoaneurysm formation, except one paralyzed swine developed of thrombo-occlusion at the site of the sutureless anastomosis. The result indicates that this novel ring connector offers considerable promise for sutureless aortic anastomosis.

Obstrucción intestinal debido a hernia estrangulada en el espacio prevesical: presentación de un caso y revisión de la literatura

Introduction: Prevesical space is an infrequent location of hernias. Prevesical hernia is a rare cause of bowel obstruction. We present a case operated at our institution and review the available evidence in literature. Case report: A 67-years-old mail, without any relevant medical history, came to the Emergency Department complaining of suprapubic pain during the last 24 h. Physical examination revealed abdominal distension and suprapubic pain. A CT scan revealed small bowel dilation with a gauge change in the pelvis. Exploring laparotomy was performed, observing a hernia in the prevesical space and 25 cm of ileal loops incarcerated with ischemic aspect. A small bowel resection and latero-lateral manual running suture anastomosis was performed. Histological findings were not relevant. The patient presented an uneventful postoperative course and was discharged the 5th day after surgery. Conclusions: Hernias in the prevesical space are infrequent causes of abdominal pain and bowel obstruction. They are located between lateral umbilical ligaments and bladder fundus, where a ring is located. They must be suspected in cases of inguinal or suprapubic pain without palpable lump in the lower abdominal quadrants. Diagnosis can be only radiologically achieved, by CT scan. Surgical treatment is mandatory, often requiring bowel resection.

Analysis of risk factors in the development of bronchopleural fistula after major anatomic lung resection: experience of a single centre

The bronchopleural fistula (BPF) is a rare but potentially fatal complication of major thoracic surgery. The purpose of this work is to investigate the risk factors associated with the development of fistulas after lobectomy and pneumonectomy. We retrospectively reviewed the records of 835 patients who underwent major anatomic lung resection at our centre from January 2003 to December 2013. Of these, 49 underwent pneumonectomy (P group) and 786 lobectomy (L group). A total of 18 patients (2.6%) developed a BPF in the postoperative period, of which there were 11 in the L group (1.3%) and seven in the P group (14.28%). The 30-day mortality was 0.05% (one patient after right pneumonectomy). In the L group, three patients developed a fistula after a left lobectomy and eight after a right one, of which four developed after bilobectomy. Univariate analysis showed that induction therapy, lower lobectomy, manual suture of the bronchus, 'not covered' bronchial stump, empyema, postoperative anaemia and pulmonary infections and mechanical ventilation >24 h are associated with the development of fistulas after lobectomy. Multivariate analysis confirmed that induction therapy, manual closure of the bronchus, postoperative pulmonary infections and anaemia are the main risk factors involved in our series. In the P group, four patients developed a fistula after a right pneumonectomy and three after a left one. Postoperative empyema and pulmonary infections, mechanical ventilation >24 h and female gender emerged as the main risk factors on univariate analysis, while on multivariate analysis, only the female gender presented a trend towards significance. Postoperative pulmonary infections, empyema and mechanical ventilation >24 h are strongly associated with the development of BPFs after both pneumonectomy and lobectomy in our series.

Early and late assessment of the surgical treatment of the pharyngoesophageal diverticulum by mechanical and manual suture

Early and late assessment of the surgical treatment of the pharyngoesophageal diverticulum by mechanical and manual suture

Arterial and venous coupling by microvascular anastomotic coupling device in head and neck reconstruction

Objective To assess the value of using microvascular anastomotic coupling device(MACD) in head and neck reconstruction, especially in arterial coupling. Our experience was summed up to improve the success rate of anastomosis. Methods This research had enrolled all patients performed free flap reconstruction in our department from January, 2015 to Auguest, 2016. The data were obtained on type of free flap, donor and recipient vessels, type of MACD, time of anastomosis and so on. Results 169 patients were included in this study. Free flap reconstructions were done by manual suture in 25 patients and MACD in 144 patients. Coupling the arteries and veins by MACD[(5.7 ± 1.2)min and (5.1 ± 1.0) min, respectively] had taken less time than manual suture[(21.4 ± 3.1)min and (23.2 ± 4.2)min, respectively]. 223 MACD were used totally to couple 44 arteries and 179 veins. There was no significant statistical difference in vascular crisis and flap survival between manual suture and MACD(P > 0.05). One arterial crisis (2.3%) and on flap loss was found in the patients coupling arteries by MACD. Conclusion MACD is a optimal method for coupling veins of free flap in head and neck reconstruction, because of high success rate and shortening surgery time. As well MACD can be a important option in arterial anastomosis after appropriate vessels choosing and pretreatments. Key words: Microvascular anastomotic device; Head and neck; Reconstruction; Surgical flap; Arterial anastomosis

Outcomes of mechanical stapling for postlaryngectomy open pharyngotomy closure

A total laryngectomy (TL) is performed as a primary or salvage therapy for laryngeal carcinoma. Pharyngotomy closure after TL is typically performed using manual sutures. Automatic stapling devices are routinely used in thoracoabdominal surgery, but have not been widely accepted for use in pharyngotomy closure. Previously described closed stapling techniques of pharyngeal closure do not allow direct evaluation of surgical margins and are limited to endolaryngeal disease. We describe an open technique for pharyngotomy closure using a mechanical stapling device. Retrospective review. A review was conducted of 16 total laryngectomies performed from May 2008 to August 2015 utilizing an Ethicon Endopath ETS Compact-Flex 45 stapler. Sixteen patients (15 male, one female), mean age 69 years, received open TL (14 salvage, two primary) with endostapler pharyngeal closure and primary tracheoesophageal puncture (TEP). Surgical time averaged 218 minutes. Median time to swallowing was 4 days (range, 2-240 days) and mean hospital stay 6 days (range, 3-10 days). Fistula incidence was 31% (5/16) overall and 36% (5/14) in the postradiation patients. Mechanical stapling is a simple method for postlaryngectomy open pharyngotomy closure. This technique allows evaluation of margins, easy primary TEP, and the opportunity for early swallowing and shorter hospital stays. In addition, it can be performed for closure of salvage laryngectomies with rates of fistula formation similar to that found in the literature using suture closure techniques. Future studies are necessary to compare oncological results and surgical complications between the open and closed stapling techniques and to traditional suture closure. 4 Laryngoscope, 127:605-610, 2017.

Outcomes after aortic graft-to-graft anastomosis with an automated circular stapler: A novel approach

ObjectivePatients with complex aortic disease often require multistaged repairs with numerous anastomoses. Manual suturing can be time consuming. To reduce ischemic time, a circular stapling device has been used to facilitate prosthetic graft-to-graft anastomoses. Objectives are to describe this technique and assess outcomes. MethodsFrom February 2009 to May 2014, 44 patients underwent complex aortic repair with a circular end-to-end anastomosis (EEA) stapler at Cleveland Clinic. All patients had extensive aneurysms: 17 after ascending dissection repair, 10 chronic type B dissections, and 17 degenerative aneurysms. Stapler was used during total arch repair as an end-to-side anastomosis (n = 36; including first stage elephant trunk [ET] in 32, frozen ET in 3) and an end-to-end anastomosis during redo thoracoabdominal repair (n = 11). Three patients had the stapler used during both stages of repair. Patients underwent early and annual follow-ups with computed tomography analysis. ResultsThere were no bleeds, ruptures, or leaks at the stapled site, but 2 patients died. Complications included 7 reoperations not related to the site of stapled anastomosis and 6 tracheostomies, but there was no paralysis or renal failure. Mean circulatory arrest time was 16 ± 5 minutes. Mean follow-up was 26 ± 17 months and consisted of imaging before discharge, at 3 to 6 months, and at 1 year. Planned reinterventions included 21 second-stage ET completion: Endovascular (n = 18) and open (n = 3). There were 4 late deaths. ConclusionsUse of an end-to-end anastomotic automated circular stapler is safe, effective, and durable in performing graft-to-graft anastomoses during complex thoracic aortic surgery. Further evaluation and refinement of this technique are warranted.

P-259 Laparoscopic gastrectomy: our technique, complications and long-term oncological results

Introduction: Although laparoscopic gastrectomy (LGE) has become a standard treatment of early gastric cancer (GC) in Japan and South Korea, it doesn't have wide spread in other World. We want to represent our experience in performing LGE with analysis of short postoperative and long oncological results. Methods: Since 2011 we have done 87 LGE with D1+ or D2 lymphadenectomy (according to Japanese Gastric Cancer Treatment Guidelines 2010 (version 3)). There were 64 total and 23 subtotal LGE among them. Distribution for stages was: IA – 2 (2.3%), IB – 7 (8.1%), IIA – 16 (18.4%), IIB – 43 (49.4%), IIIA – 8 (9.2%), IIIB – 6 (6.9%), IIIC – 5 (5.7%). Thus 79 (90.8%) of patients had advanced stage (cT3-4, N0-2) and 82 (94.3%) received perioperative chemotherapy. In 10 cases extended resections were done: splenectomy (4), colon resection (2), hepatic (3), distal pancreatic (1). We used 5-6 trocars and 5-6 cm laparotomy for specimen extraction. In 6 cases transvaginal route for specimen retrieval were used. Anastomoses after Roux-an-Y reconstruction were performed using circular staplers (37), linear (45) and intracorporeal manual suture (5) for BI-reconstruction after distal LG. Results: Mean age was 57.8 (37-78) years. Mean operating time - 245 (160-550) minutes for total LGE and 235 (155-420) – for subtotal. Mean intraoperative blood loss - 95 (50-1100) ml. Mean postoperative hospital stay - 7.9 (4-24) days. Mean number of resected lymph nodes - 24.3 (8-60). All patients had R0 resection margins. There were no conversions to laparotomy. 30-day postoperative complications were registered in 28 (32.2%) patients. Among them grade IIIB-IV complications (according to Clavien-Dindo, 2004 classification) were in 12 (13.8%). Anastomotic leaks occurred in 5 (5.7%). Reoperations were done in 8 (9.2%). Reasons for reoperation were: anastomotic leak (4), bleeding (3) and anastomotic stricture (1). Mortality rate was 2.3% (2 patients died). Long-term oncologic results were assessed in 72 cases. One-year overall survival rate was 80.1%, 2-year – 64.3%, 3-year – 62.7% and 4-year – 55.6%. One-year progression-free survival (PFS) rate was 64.4%. PFS rates for 2, 3 and 4-years were 53.6, 52.9 and 50.3% respectively. Conclusion: Laparoscopic gastrectomy is feasible and safe method for patients even with advanced stage of gastric cancer. It has acceptable postoperative and long-term oncological outcomes in compare with open procedure.

Intracorporeal reconstruction after laparoscopic pylorus-preserving gastrectomy for middle-third early gastric cancer: a hybrid technique using linear stapler and manual suturing.

Laparoscopy-assisted pylorus-preserving gastrectomy has been increasingly reported as a treatment for early gastric cancer located in the middle third of the stomach because of its low invasiveness and preservation of pyloric function. Advantages of a totally laparoscopic approach to distal gastrectomy, including small wound size, minimal invasiveness, and safe anastomosis, have been recently reported. Here, we introduce a new procedure for intracorporeal gastro-gastrostomy combined with totally laparoscopic pylorus-preserving gastrectomy (TLPPG). The stomach is transected after sufficient lymphadenectomy with preservation of infrapyloric vessels and vagal nerves. The proximal stomach is first transected near the Demel line, and the distal side is transected 4 to 5cm from the pyloric ring. To create end-to-end gastro-gastrostomy, the posterior wall of the anastomosis is stapled with a linear stapler and the anterior wall is made by manual suturing intracorporeally. We retrospectively assessed the postoperative surgical outcomes via medical records. The primary endpoint in the present study is safety. Sixteen patients underwent TLPPG with intracorporeal reconstruction. All procedures were successfully performed without any intraoperative complications. The mean operative time was 275min, with mean blood loss of 21g. With the exception of one patient who had gastric stasis, 15 patients were discharged uneventfully between postoperative days 8 and 11. Our novel hybrid technique for totally intracorporeal end-to-end anastomosis was performed safely without mini-laparotomy. This technique requires prospective validation.

Comparative Study of High Powerful Magnet with Conventional Repair of Suture in the Intestinal Anastomosis of Rats

Background In this study, given the importance of gastrointestinal anastomosis in surgical procedures, attempts have been made to compare the results of employing magnetic compression anastomosis and magnetic coils in intestinal anastomosis of rats. Materials and Methods This study was an experimental trial on 60 rats which had been randomly divided into two experiment (30) and control (30) groups. First, the rat intestine was cut off from a relatively fixed point and then magnet anastomosis was performed at the both ends of bowel in the control group and manual suture in the experiment group. Anastomosis was then examined 10 days after the surgery for possible complications with a histological analysis of the indices of tissue repair. Results The mean time required for performing anastomosis of the rat intestine was 735 and 366 seconds for the control and experiment groups, respectively. Also, the laparotomy performed 10 days after the first operation did not show any significant difference between two groups in terms of surgical complications such as infiltration factor of inflammatory cell and fibroblast activity (P>0.05). The microscopic examination indicated that the tissue reaction in the anastomosis site was better in terms of tissue repair of neo-angiogenesis intestine and collagen deposition in the magnet group(P>0.05). Conclusion Given the shorter duration of the anastomosis by magnets and more favorable histological results reported in the experiment group, as well as the lack of any significant difference in complications of the two techniques, magnetic compressive anastomosis can be used as a new technique for intestinal surgeries and pertaining anastomosis. Although, we recommend that study will be done with large sample size to obtain reliable results.

Laparoscopic and endoscopic co-operative surgery for non-ampullary duodenal tumors.

AIMTo assess the safety and feasibility of laparoscopic and endoscopic co-operative surgery (LECS) for early non-ampullary duodenal tumors.METHODSTwelve patients with a non-ampullary duodenal tumor underwent LECS at our hospital. One patient had two mucosal lesions in the duodenum. The indication for this procedure was the presence of duodenal tumors with a low risk for lymph node metastasis. In particular, the tumors included small (less than 10 mm) submucosal tumors (SMT) and epithelial mucosal tumors, such as mucosal cancers or large mucosal adenomas with malignant suspicion. The LECS procedures, such as full-thickness dissection for SMT and laparoscopic reinforcement after endoscopic submucosal dissection (ESD) for epithelial tumors, were performed for the 13 early duodenal lesions in 12 patients. Here we present the short-term outcomes and evaluate the safety and feasibility of this new technique.RESULTSTwo SMT-like lesions and eleven superficial epithelial tumor-like lesions were observed. Seven and Six lesions were located in the second and third parts of the duodenum, respectively. All lesions were successfully resected en bloc. The defect in the duodenal wall was manually sutured after resection of the duodenal SMT. For epithelial duodenal tumors, the ulcer bed was laparoscopically reinforced via manual suturing after ESD. Intraoperative perforation occurred in two out of eleven epithelial tumor-like lesions during ESD; however, they were successfully laparoscopically repaired. The median operative time and intraoperative estimated blood loss were 322 min and 0 mL, respectively. Histological examination of the tumors revealed one adenoma with moderate atypia, ten adenocarcinomas, and two neuroendocrine tumors. No severe postoperative complications (Clavien-Dindo classification grade III or higher) were reported in this series, but minor leakage secondary to pancreatic fistula occurred in one patient.CONCLUSIONLECS can be a safe and minimally invasive treatment option for non-ampullary early duodenal tumors.

Intracorporeal manual suture on the bladder for traumatic rupture

Intracorporeal manual suture on the bladder for traumatic rupture

Locked Temporary Vascular Shunt for Wartime Vascular Injuries.

IntroductionTo reduce the ischaemia time of injured limbs in wartime, temporary vascular shunts (TVS) are commonly used. However, TVS are stabilized at the ends of the injured vessels using manual suture ties, the risk of dislodgement is high, and tightening manual suture ties is too time consuming.Technical summaryLocked temporary vascular shunts (LTVS) were designed, and each was composed of a silicone tube with a threaded outer surface and smooth inner surface in addition to two nylon buckle switches. The buckle switches were used to stabilize the silicone tube of the LTVS with respect to the vessel walls. This job was performed with two manual suture ties with the current TVS. The mean bursting pressure value of the veins shunted with the LTVS was 114.3% higher than that of the veins shunted with the TVS (0.045 ± 0.008 MPa vs. 0.021 ± 0.012 MPa; p = .00). Although the mean shunting time of the LTVS was reduced by 60.4% compared with that of the TVS (138.89 ± 18.22 seconds vs. 350.48 ± 52.20 seconds; p = .00), there was no significant difference in the patency times between the two types of devices (8.20 ± 9.01 hour vs. 8.40 ± 8.85 hour; p = .98).ConclusionThe LTVS, which was designed to treat wartime vascular injuries, might be safer and more efficient than the current TVS.

Absence of postoperative pulmonary impermeability in patients with spontaneous pneumothorax

to improve treatment of patients with spontaneous pneumothorax who had not postoperative pulmonary impermeability. 87 patients with spontaneous pneumothorax underwent videothoracoscopy (VTS), lung resection supplemented by pleurodesis (parietal pleurectomy or pleural abrasion). Absence of pulmonary impermeability was observed in 5 (5.7%) patients. Re-operation was performed in 2 patients (Vanderschuren 2 and 3) namely re-thoracoscopy and thoracotomy with additional ligation of air origins. Drainage tubes were removed in 4 and 17 days postoperatively in patient without/with emphysema respectively. In patient (Vanderschuren 1) who underwent thoracoscopic resection and parietal pleural abrasion valve bronchoblocation was performed in 9 days after VTS due to persistent pneumothorax. Pleural drainage tube was removed in 13 days (emphysema) after bronchial valve deployment. 2 patients (Vanderschuren 4) had heterogeneous pulmonary emphysema. One of them underwent video-assisted mini-thoracotomy, lung resection with reinforcement of seams with synthetic material. In other observation conversion to thoracotomy followed by atypical resection of bullous emphysema and manual suturing of lung was applied. In both cases bronchoblocation was performed intraoperatively with good results. Drainage tubes were removed in 13 and 17 days respectively. There were no complications. Intraoperative endoscopic bronchoblocation is advisable if air leakage is considerable in operating theater and complicates lung smoothing. Such approach reduces hospital-stay and improves outcomes.

Chronic gastric obstruction due to giant trichobezoar in an adult with Rapunzel syndrome

A 46-year-old woman was admitted to psychiatric ward accomanied by parents for delirium during acute phase of psychosis. uring following days a voluminous non-painful mass in the left pper quadrant of abdomen was noted. Detailed studies of medcal history reveal a story of nausea and vomiting during last onths and weight loss. A contrast enhanced CT scan was perormed and the images were suggestive for impressive gastric ilatation sustained by a giant bezoar (Fig. 1). The diagnosis was hen confirmed during endoscopic procedure during which was mpossible to remove the bezoar due to impossibility to fragment t in smaller pieces. A laparotomy was planned, the trichobezoar as removed through a 10 cm longitudinal gastrotomy on the nterior gastric wall (Fig. 2). The gastrotomy was repaired with linar mechanical stapler and a reinforcement with manual suture.

Successful Intracorporeal Suturing Following Laparoscopic Resection of a Large Gastrointestinal Stromal Tumor Located at the Esophagogastric Junction

Laparoscopic partial resection of gastric gastrointestinal stromal tumors (GISTs) ≤5 cm in size is widely performed, whereas that of large GISTs (size &amp;gt;5 cm) is controversial because of oncologic and technical safety. Furthermore, laparoscopic resection of GISTs located at the esophagogastric junction (EGJ) is difficult because of the high risk of narrowing or/and deformity of the EGJ. In the current study we report a case of laparoscopic partial resection of a large GIST located at the EGJ. A 74-year-old female patient visited our institution complaining of epigastric discomfort. An esophagogastroduodenoscopy and an abdominal computed tomography scan revealed a 7.5 × 4.0 cm GIST at the EGJ and upper stomach. The patient underwent laparoscopic partial resection with intracorporeal suturing, without any breakage of the pseudocapsule. The defect of the esophagogastric wall after resection was closed by intracorporeal running suture. The patient's postoperative course was uneventful. To the best of our knowledge, this is the first report of laparoscopic resection of a large GIST located at the EGJ. Our technique of intracorporeal manual suturing following laparoscopic gastric resection can be a valid option for minimally invasive surgery for a large GIST located at the EGJ.