Serosal and muscular layers incision technique in laparoscopic surgery for gastric gastrointestinal stromal tumors

Fujishima, Hajime; Etoh, Tsuyoshi; Akagi, Tomonori; Tajima, Masaaki; Shibata, Tomotaka; Ueda, Y.; Tojigamori, Manabu; Shiroshita, Hidefumi; Shiraishi, Norio; Kitano, Seigo; Ito, Masafumi

doi:10.1111/ases.12327

Cited by 9 publications

(12 citation statements)

References 16 publications

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“…Fujishima et al reported a modified CLEAN-NET technique, modifying the resection and closure procedure using laparoscopic stapling devices from full-layer stapling to only mucosal layer and adding seromuscular closure by handsewn suturing. This technique enabled resect the gastric SMTs near the EGJ or the pyloric ring without any stenosis [21]. In our case, the tumor was over 3 cm and located at the posterior wall near the cardia of the stomach.…”

Section: Discussionmentioning

confidence: 74%

Diagnosis and treatment of gastric hamartomatous inverted polyp (GHIP) using a modified combination of laparoscopic and endoscopic approaches to neoplasia with a non-exposure technique (modified CLEAN-NET): a case report

et al. 2020

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Background: Gastric hamartomatous inverted polyp (GHIP) is a pathological condition where enlarged gastric glands with cystic dilatation grow in the submucosa. It is difficult to excise the tissue due to its location. In addition, even if the tissue is taken correctly, making an accurate diagnosis is difficult due to foveolar epithelium in the tissue, which can be misdiagnosed as gastric mucosal epithelium. Thus, an accurate diagnosis of GHIP is rarely established from a biopsy alone preoperatively. We here report a case of GHIP with a central dimple, which was diagnosed and treated using a modified combination of laparoscopic and endoscopic approaches to neoplasia with a non-exposure technique (modified CLEAN-NET). Case presentation: A 60-year-old man with a submucosal tumor (SMT) in the stomach was referred to our hospital by a primary care doctor. On examination, a gastrointestinal stromal tumor was suspected. Modified CLEAN-NET was performed for diagnostic and therapeutic purposes. The histopathological examination of the resected specimen showed an enlarged gland duct in the submucosal layer. This finding, along with immunostaining results, led to the diagnosis of GHIP. The postoperative course was uneventful without any symptoms. Conclusions: GHIP should be considered among the differential diagnoses of SMT of the stomach. Modified CLEAN-NET may be beneficial in the removal of SMTs such as GHIP with a central dimple because it can avoid stomach deformation of the stomach and tumor dissemination.

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Section: Discussionmentioning

confidence: 74%

Diagnosis and treatment of gastric hamartomatous inverted polyp (GHIP) using a modified combination of laparoscopic and endoscopic approaches to neoplasia with a non-exposure technique (modified CLEAN-NET): a case report

et al. 2020

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“…The mucosal tissue is pulled out toward the outside of the stomach and the stretched mucosa is cut together with a minimal area of the full layer of the stomach wall. The greatest feature of these procedures is their non‐exposure technique, which may eliminate the risk of tumor cell seeding in patients with GIST with ulceration …”

Section: Discussionmentioning

confidence: 99%

“…However, a recent study showed that this style of surgery did not increase the risk of dissemination even in GIST with ulceration . The CLEAN‐NET, Lift and Cut, or SAMIT (laparoscopic wedge resection with the serosal and muscular layers incision technique) approaches all use a seromuscular incision to preserve the continuity of the mucosa, which works as a stretched a barrier in “CLEAN‐NET” . The mucosal tissue is pulled out toward the outside of the stomach and the stretched mucosa is cut together with a minimal area of the full layer of the stomach wall.…”

Section: Discussionmentioning

confidence: 99%

“…The greatest feature of these procedures is their nonexposure technique, which may eliminate the risk of tumor cell seeding in patients with GIST with ulceration. 19,20,23,24 There is another laparoscopic technique designed to resect tumors by gastrotomy, which can be divided into two types of surgery, transgastric and intragastric surgery. 18,25,26 In transgastric surgery, an anterior gastric incision is made, and the tumor is removed under a good visual field through the incision.…”

Section: Ost G-smt Including Gist Usually Growmentioning

confidence: 99%

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Comparison between endoscopic and laparoscopic removal of gastric submucosal tumor

Abe

Takeuchi

Ohki

et al. 2018

Digestive Endoscopy

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Results: The ER group had a significantly higher percentage of intraluminal growing type of tumor (100% vs 41%) and smaller tumor size (23 vs 33 mm) than the LR group. The ER group had a significantly shorter operative time (93 vs 145 min) and less blood loss (13 vs 30 mL) than the LR group. In the ER group, three patients who had tumors located on the anterior wall of the stomach required laparoscopic closure after EFTR because of difficulty in endoscopic closure of the gastric-wall defect. Postoperative complication rates and duration of postoperative hospital stays did not differ between the two groups.Conclusions: ER may be technically feasible, safe, less invasive, and oncologically appropriate options for selected patients with the intraluminal growing type of G-SMT smaller than 30 mm. EFTR may be more reasonable alternatives to LR in selected patients with a small G-SMT located on the lesser curvature side.

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“…Laparoscopic endoscopic cooperative surgery (LECS) and modified LECS procedures such as inverted LECS, non-exposed endoscopic wall-inversion surgery (NEWS), combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET), serosal and muscular layers incision technique (SAMIT) have been recently developed to achieve partial resection with minimal gastric deformity. 1,2 Each technique has advantages and disadvantages; the appropriate technique is selected based on tumor characteristics. Intragastric surgery is another effective procedure which helps prevent deformities, especially for submucosal intraluminal tumors located around the esophagogastric junction (EGJ).…”

Section: Introductionmentioning

confidence: 99%

Hybrid approach with laparoscopic wall‐inversion surgery and single‐incision intragastric surgery for intraluminal gastrointestinal stromal tumor: A case report

Kusunoki

Hamakawa

Nishikawa

et al. 2021

Asian J Endoscop Surgery

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Laparoscopic wedge resection (LWR) for intraluminal gastrointestinal stromal tumor (GIST) leads to excessive resection of normal gastric wall. We report a case of GIST around the cardia successfully treated with full-thickness partial resection using a hybrid approach of laparoscopic surgery and single-incision intragastric surgery (SIIGS). A 69-year-old woman had a 5 cm intraluminal GIST at the posterior wall around the cardia. Submucosal injection of glycerin and indigo carmine was performed with transoral endoscopy. Circumferential seromuscular incision followed by placement of seromuscular sutures to invert the lesion into the stomach was performed under laparoscopy. By SIIGS, resection of the inverted mucosa and retrieval of the tumor were completed. A hybrid approach consisting of laparoscopic wall-inversion surgery and SIIGS was useful for intraluminal GIST and may expand the indications for laparoscopic wall-inversion surgery by removing size limitations.

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Serosal and muscular layers incision technique in laparoscopic surgery for gastric gastrointestinal stromal tumors

Abstract: Laparoscopic wedge resection with SAMIT is technically and oncologically safe. It is useful for treating gastric gastrointestinal stromal tumors, including those close to the esophagogastric junction or pyloric ring.

Cited by 9 publications

References 16 publications

Diagnosis and treatment of gastric hamartomatous inverted polyp (GHIP) using a modified combination of laparoscopic and endoscopic approaches to neoplasia with a non-exposure technique (modified CLEAN-NET): a case report

Diagnosis and treatment of gastric hamartomatous inverted polyp (GHIP) using a modified combination of laparoscopic and endoscopic approaches to neoplasia with a non-exposure technique (modified CLEAN-NET): a case report

Comparison between endoscopic and laparoscopic removal of gastric submucosal tumor

Hybrid approach with laparoscopic wall‐inversion surgery and single‐incision intragastric surgery for intraluminal gastrointestinal stromal tumor: A case report

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