Novel Technique For Resection Research Articles

Endoscopic sutured purse-string resection: a novel technique for resection of large gastric subepithelial lesions.

Endoscopic sutured purse-string resection: a novel technique for resection of large gastric subepithelial lesions.

A Novel Technique for Resection and Reconstruction of the Temporomandibular Joint by Sliding Vertical Ramus Osteotomy using Only Submandibular Approach.

In this paper, an innovative technique for resection and reconstruction of the temporomandibular joint by sliding vertical ramus osteotomy using only a submandibular approach is presented. Before pulling the posterior mandibular border slightly downward to expose parts of the condyle, the vertical ramus osteotomy was performed. With the help of 3D simulation and surgical templates, the condylectomy was carried out using the ultrasonic osteotome through the submandibular approach. Our technique achieved the desired results while preventing complications of facial nerve paralysis, the occurrence of Frey syndrome, and the preauricular scar. Therefore, we suggest that this surgical method represents an alternative treatment option for temporomandibular joint lesions.

Dissection-enabled scaffold-assisted resection (DeSCAR): a novel technique for resection of residual or non-lifting gastrointestinal neoplasia of the colon, expanded experience and follow-up.

Background and study aims Colonic lesions may not be amenable to conventional endoscopic mucosal resection (EMR) due to previous manipulation, submucosal invasion, or lesion flatness. In 2018, we described Dissection-enabled Scaffold Assisted Resection (DeSCAR) to be safe for the endoscopic resection of non-lifting or residual colonic lesions 1 In this study, we expand our original cohort to describe our expanded experience with patients undergoing DeSCAR and assess the efficacy, safety, and feasibility of DeSCAR for endoscopic resection of non-lifting or residual colonic lesions. Patients and methods We retrospectively reviewed 57 patients from 2015–2019 who underwent DeSCAR for colonic lesions with incomplete lifting and/or previous manipulation. Cases were reviewed for location, prior manipulation, rates of successful resection, adverse events, and endoscopic follow up to assess for residual lesions. Results Fifty-seven lesions underwent DeSCAR. Of the patients, 51 % were female, and average patient age was 69 years. Lesions were located in the cecum (n = 16), right colon (n = 27), left colon (n = 10), and rectum (n = 4). Average lesion size was 27.7 mm. Previous manipulation occurred in 54 cases (72 % biopsy, 44 % resection attempt, 18 % intralesional tattoo). The technical success rate for resection of non-lifting lesions was 98 %. There were two delayed bleeding episodes (one required endoscopic intervention) and one small perforation (managed by endoscopic hemoclip closure). Endoscopic follow up was available in 31 patients (54 %) with no residual adenoma in 28 patients (90 % of those surveilled). Conclusions Our expanded experience with DeSCAR demonstrates high safety, feasibility, and effectiveness for the endoscopic management of non-lifting or residual colonic lesions.

914 Dissection-Enabled Scaffold-Assisted Resection (DeSCAR): A Novel Technique for Resection of Residual or Non-Lifting GI Neoplasia of the Colon, Expanded Experience and Follow-Up

INTRODUCTION: Colonic lesions referred for endoscopic mucosal resection (EMR) may not be amenable to conventional snare resection due to previous manipulation or submucosal invasion or because of flat lesions unable to be snared. In 2018, we initially described Dissection-enabled Scaffold Assisted Resection (DeSCAR)—a combination of circumferential endoscopic submucosal dissection (ESD) with EMR—to be safe for the endoscopic resection for removal of non-lifting or residual colonic lesions with suspected submucosal involvement or fibrosis. We describe our expanded experience and follow up of patients undergoing DeSCAR and assess the efficacy, safety, and feasibility of DeSCAR for endoscopic resection of non-lifting or residual colonic lesions. METHODS: Lesions referred for EMR were retrospectively reviewed. Our initial cohort of 29 patients from 2015-2017 combined with 28 additional patients from 2018-2019 were identified where the DeSCAR technique was performed for colonic lesions with incomplete lifting and/or snaring. Cases were reviewed for location, prior manipulation, rates of successful hybrid resection, adverse events, and endoscopic follow up to assess for residual lesions. RESULTS: 57 lesions underwent DeSCAR for non-lifting or residual colonic lesions. Patients were 51% female and 49% male with an average age 69 (SD +/- 9.6 yrs). Lesions were located in the cecum (n = 16), right colon (n = 22), transverse colon (n = 5), left colon (n = 7), rectum (n = 4), or in other locations defined by distance from the anus (n = 4). Average lesion size was 27.7 mm (SD +/- 16.6 mm). Previous manipulation occurred in 54 of 57 cases (68% biopsy, 47% resection attempt, 18% intralesional tattoo). The technical success rate for resection of non-lifting lesions was 100%. There were two delayed bleeding episodes (one required endoscopic intervention) and one small perforation (managed by successful endoscopic hemoclip closure at the time of perforation). No other adverse events were observed. Endoscopic follow up was available in 27 patients (47%) with no residual adenoma noted in 25 patients (93% of those with surveillance). CONCLUSION: Our expanded experience with DeSCAR continues to demonstrate a high safety, feasibility, and effectiveness profile for the endoscopic management of non-lifting or residual colonic lesions, providing en-bloc resection of tissue for histologic review. Further studies are needed to demonstrate long-term eradication and direct comparison with other currently available endoscopic techniques.

Dissection-enabled scaffold-assisted resection (DeSCAR): a novel technique for resection of residual or non-lifting GI neoplasia of the colon (with video)

As a result of previous manipulation or submucosal invasion, GI lesions referred for EMR frequently have flat areas of visible tissue that cannot be snared. Current methods for treating residual tissue may lead to incomplete eradication or not allow complete tissue sampling for histologic evaluation. Our aim is to describe dissection-enabled scaffold-assisted resection (DeSCAR), a new technique combining circumferential ESD with EMR for removal of superficial non-lifting or residual "islands" with suspected submucosal involvement/fibrosis. From 2015 to 2017, lesions referred for EMR were retrospectively reviewed. Cases were identified where lifting and/or snaring of the lesion was incomplete and the DeSCAR technique was undertaken. Cases were reviewed for location, previous manipulation, rates of successful hybrid resection, and adverse events. Twenty-nine lesions underwent DeSCAR because of non-lifting or residual "islands" of tissue. Fifty-two percent of the patients were male and 48% were female; average age was 66 years (standard deviation ±9.9 years). Lesions were located in the cecum (n= 10), right side of the colon (n= 12), left side of the colon (n= 4), and rectum (n= 3). Average size was 31mm (standard deviation ±20.6mm). Previous manipulation had occurred in 28 of 29 cases (83% biopsy, 34% resection attempt, 52% tattoo). The technical success rate for resection of non-lifting lesions was 100%. There was one episode of delayed bleeding but no other adverse events. DeSCAR is a feasible and safe alternative to argon plasma coagulation and avulsion for the endoscopic management of non-lifting or residual GI lesions, providing en bloc resection of tissue for histologic review. Further studies are needed to demonstrate long-term eradication and for comparison with other methods.

Mo2008 Dissection-Enabled Scaffold Assisted Resection and Descar and a Novel Technique for Resection of Residual or Non-Lifting Gastrointestinal Neoplasia

Mo2008 Dissection-Enabled Scaffold Assisted Resection and Descar and a Novel Technique for Resection of Residual or Non-Lifting Gastrointestinal Neoplasia

Ligation-assisted endoscopic dissection： a novel technique for resection of small gastric tumors originating from muscularis propria

Objective To evaluate the efficacy and safety of ligation-assisted endoscopic dissection （ED-L） technique for the removal of gastric tumors originating from muscularis propria. Methods A total of 33 patients with gastric tumors originating from muscularis propria less than 10 mm were treated with ED-L procedures. The tumor was ligated by elastic hands. Endoscopic dissection was performed until the tumor was partially or completely dissected from muscularis propria by using Hook knife and/or IT-knife. The wound was closed with metallic clips and medical adhesive. The patients were followed up 1 week, 1 month, 3 months, 6 months and 12 mouths thereafter with endoscopy, respectively. Results Of the 33 gastric tumors, there were 25 partial dissections and 8 complete dissections. All of the tumors sloughed completely. Pathological diagnoses of all the patients were acquired. No complications like perforation occurred except for one self-limiting and non-life-threatening hemorrhage. There was no recurrent case during the 3-18 months of follow-up period. Conclusion ED-L is a safe, effective and relatively simple technique for excision of small gastrointestinal tumors originating from muscularis propria, providing a histopathological diagnosis as well. Key words: Stomach ; Endoscopic ultrasonography ; Tumors originating from muscularis propria; Ligation-assisted endoscopic dissection

Transcervical Video-Assisted Resection of Zenker's Diverticulum

We report a novel technique for resection of symptomatic Zenker's diverticulum. Two consecutive patients underwent a transcervical video-assisted dissection and resection of Zenker's diverticular pouch. Both patients exhibited good anatomical and functional results at 10 months follow-up.

Widespread EMR: a new technique for removal of large areas of mucosa

Widespread EMR is a novel technique for resection of large areas of mucosa as a single bloc. Large lesion size (>2 cm) is a recognized limitation of current EMR techniques. This study assessed the technical feasibility, efficacy, and safety of widespread EMR in a porcine model. Widespread EMR was performed in 6 pigs. A submucosal fluid cushion was created in the distal esophagus by using a 0.83% solution of hydroxypropyl methylcellulose. A mucosal strip 5 cm in length and including at least 50% of the luminal circumference was marginated by using a prototype cutting device. The proximal end of the mucosa was stripped from the submucosa by using a grasping forceps. The distal end was snare resected. Resected tissue was assessed histologically. Endoscopy was repeated at weeks 1 and 6. At week 6, a second widespread EMR of the mucosa on the wall opposite the initial resection was attempted to create a full circumferential resection. Widespread EMR was completed in all animals. The esophagus was denuded of mucosa in 5-cm lengths that included 50% of the circumference of the lumen. No procedure-related complication was observed. Histologic assessment demonstrated that the resection specimen included mucosa and submucosa but not muscularis propria. Endoscopy at 1 week revealed mucosal regrowth in two animals and ulceration in 4. At week 6, regrowth of mucosa was noted in all animals. The second wide EMR proved to be technically difficult and was associated with perforation, peri-esophageal abscess, and stricture formation. Wide EMR appears to be technically feasible for removal of large areas of mucosa. Mucosal strips 5 cm long that included over 50% of the luminal circumference were resected safely. Resection was followed by complete regrowth of the mucosa. However, a second wide EMR to create a circumferential resection proved to be technically difficult and unsafe.