Clin Endosc.  2018 Mar;51(2):167-173. 10.5946/ce.2017.076.

Non-Exposure Endoscopic-Laparoscopic Cooperative Surgery for Stomach Tumors: First Experience from the Czech Republic

• Hajer J
• Havlůj L
• Whitley A
• Gürlich R

• KMID: 2410984
• DOI: http://doi.org/10.5946/ce.2017.076

Abstract

BACKGROUND/AIMS
The aim of this study was to investigate the use of non-exposure endoscopic wall-inversion surgery (NEWS) and the combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET) in gastric tumors.
METHODS
We reviewed all cases of NEWS and CLEAN-NET performed in the department of surgery of the Royal Vinohrady Teaching Hospital.
RESULTS
Our department performed 12 gastric tumor resections (NEWS, n=10 and CLEAN-NET, n=2) between March 2016 and February 2017. The cases chosen for these resections included predominantly submucosal tumors with no signs of dissemination or local invasion and early gastric carcinomas (T1SM1 and T1M), where tumor location made it impossible to use endoscopic submucosal dissection. R0 resection margins were confirmed in all the cases.
CONCLUSIONS
NEWS and CLEAN-NET allow en bloc non-exposed full-thickness gastric wall resection in a way that uses a "close first, cut later" approach to prevent seeding of the peritoneal cavity with tumor cells. These mini-invasive techniques combine laparoscopic and endoscopic techniques, and preserve the full function of the stomach.

Keyword

Gastrointestinal stromal tumors; Stomach; Endoscopy; Laparoscopy

MeSH Terms

Czech Republic*
Endoscopy
Gastrointestinal Stromal Tumors
Hospitals, Teaching
Laparoscopy
Peritoneal Cavity
Stomach*

Figure

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  Fig. 1. Position of the team.

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  Fig. 2. Non-exposure endoscopic wall-inversion surgery. (A) Endoscopic view of a gastrointestinal stromal tumor of the stomach. (B) Marking the lesion with electrocautery. (C) Injection of methylene blue dye into the lesion. (D) Visualisation of the stained lesion on the serosal surface of the stomach. (E) A circumferential seromuscular incision around the lesion. (F) A suture placed around the lesion. (G) Inversion of the tumor into the stomach. (H) Circumferential muco-submucosal dissection. (I) Hemostatic clips applied to the stomach wall to achieve hemostasis.

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  Fig. 3. Combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique. (A) Endoscopic view of a gastrointestinal stromal tumor of the stomach. (B) Marking the lesion with electrocautery. (C) Injection of methylene blue dye into the lesion. (D) A circumferential seromuscular incision. (E) Sutures placed around the lesion. (F) The tumor with the surrounding submucosa elevated away from the stomach wall. (G) Resection of the tumor with a stapler. (H) Suture of the stomach wall on the serosal surface. (I) Suture of the stomach wall on the mucosal surface.

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