Total inverse transgastric resection with transoral specimen removal

Lamm, Sebastian H.; Steinemann, Daniel C.; Linke, Georg R.; Eucker, Dietmar; Simon, Thomas R.; Zerz, Andreas; Stoll, Reinhard

doi:10.1007/s00464-014-4037-1

Cited by 10 publications

(3 citation statements)

References 27 publications

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“…With the concept and advances in LECS [ 7 , 8 , 9 , 10 , 11 ] by a multidisciplinary team, we modified and simplified the backup surgery after endoscopic resection [ 31 ] regardless of tumor location. Although a previous retrospective study demonstrated that laparoscopic wedge resection could also treat tumors in an unfavorable location in the lesser curvature or the posterior wall of the gastric body, fundus, and antrum [ 32 ], different methods with endoscopic submucosal tunneling [ 18 ], laparoscopic transgastric approach [ 32 , 33 ], and anatomic gastrectomy [ 34 ] have been reported to avoid lumen stenosis in tumors located near the gastroesophageal junction or the prepyloric area. In our study, once the tumor was easily identified after incomplete ER, the surgeon completed resection using a laparoscopic stapling device and adjusted to the transverse direction of the stomach in the junction area to minimize the resected volume and preserve the greatest function.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Resection for Gastric Subepithelial Tumor with Backup Laparoscopic Surgery: Description of a Single-Center Experience

Chang

Tsao

Yen

et al. 2021

JCM

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The aim of this study was to analyze patients who underwent endoscopic resection (ER) for gastric subepithelial tumors (SETs) with a high probability of surgical intervention. Between January 2013 and January 2021, 83 patients underwent ER at the operation theater and 27 patients (32.5%) required backup surgery mainly due to incidental perforation or uncontrolled bleeding despite endoscopic repairing. The tumor was predominantly located in the upper-third stomach (81%) with a size ≤ 2 cm (69.9%) and deep to the muscularis propria (MP) layer (92.8%) but there were no significant differences between two groups except tumor exophytic growth as a risk factor in the surgery group (37% vs. 0%, p < 0.0001). Patients in the ER-only group had shorter durations of procedure times (60 min vs. 185 min, p < 0.0001) and lengths of stay (5 days vs. 7 days, p < 0.0001) but with a higher percentage of overall morbidity graded III (0% vs. 7.1%, p = 0.1571). After ER, five patients (6%) had delayed perforation and two (2.4%) required emergent laparoscopic surgery. Neither recurrence nor gastric stenosis was reported during long-term surveillance. Here, we provide a minimally invasive strategy of endoscopic resection with backup laparoscopic surgery for gastric SETs.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Resection for Gastric Subepithelial Tumor with Backup Laparoscopic Surgery: Description of a Single-Center Experience

Chang

Tsao

Yen

et al. 2021

JCM

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“…These approaches include tumor enucleation, exogastric wedge resection, transgastric tumor-everting resection, intragastric tumor everting resection, laparoscopic and endoscopic cooperative surgery and esophagogastrectomy [8][9][10][11] .…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic transgastric resection of gastric submucosal tumor located near the esophagogastric junction

Priego¹,

Cuadrado²,

García-Moreno³

et al. 2018

MIS

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Aim: Laparoscopic wedge resection is widely accepted as the choice of treatment for gastric submucosal tumors (GST). However, tumors on the posterior wall at the esophagogastric junction (EGJ) are difficult to approach. Laparoscopic transgastric resection (LTR) is a novel technique to remove gastric tumors that are unresectable by endoscopy due to their size and location. The aim of the article is to assess the feasibility and oncological outcomes of this laparoscopic approach for intraluminal GST located in the posterior wall and near the EGJ. Methods:A retrospective analysis of all patients with GST located at the EGJ who underwent LTR at our institution from January 2015 to February 2016 was performed. Results:Of the 4 patients who underwent LTR, 3 were female and 1 was male, with a mean age of 74.5 years. LTR was successfully performed in all the cases. All patients received a complete resection with negative margins. Histopathologic diagnoses were gastrointestinal stromal tumor in 2 cases and leiomyoma in the other 2. Median tumor size was 3.45 cm. The mean operation time was 173 min (range 120-232 min). One patient experienced a postoperative hematemesis, but was treated conservatively. The mean postoperative stay was 8 days (range 4-15 days). Conclusions:LTR is feasible and difficult localizations can be reached with ease. It is an appropriate alternative to laparoscopic wedge resections especially for localizations that cannot be accessed by laparoscopy such as tumors located near the EGJ.

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“…If the gastric wall is the abdominal wall, EATR is an open surgery, LIGS is a laparoscopic surgery, and SI-IGR is a single-port laparoscopic surgery [ 2 26 27 ]. In the case of SI-IGR, because there are no obstacles in trocar insertion and fixation (in contrast to LIGS), it can be performed quicker and more conveniently.…”

Section: Lecs Procedures For Benign Gastric Tumorsmentioning

confidence: 99%

Choice of LECS Procedure for Benign and Malignant Gastric Tumors

2021

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Laparoscopic endoscopic cooperative surgery (LECS) refers to the endoscopic dissection of the mucosal or submucosal layers with laparoscopic seromuscular resection. We recommend a treatment algorithm for the LECS procedure for gastric benign tumors according to the protruding type. In the exophytic type, endoscopic-assisted wedge resection can be performed. In the endophytic type, endoscopic-assisted wedge resection of the anterior wall is relatively easy to perform, and endoscopic-assisted transgastric resection, laparoscopic-assisted intragastric surgery, or single-incision intragastric resection in the posterior wall and esophagogastric junction (EG Jx) can be attempted. We propose an algorithm for the LECS procedure for early gastric cancer according to the tumor location. The endoscopic submucosal dissection (ESD) procedure can be adapted for all areas of the stomach, and single-incision ESD can be performed in the mid to high body and the EG Jx. In full-thickness gastric resection, laparoscopy-assisted endoscopic full-thickness resection can be adapted for the entire area of the stomach, but it cannot be applied to the pyloric and EG Jx. In conclusion, surgeons need to select the LECS procedure according to tumor type, tumor location, the surgeon's individual experience, and the situation of the institution while also considering the advantages and disadvantages of each procedure.

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Total inverse transgastric resection with transoral specimen removal

Cited by 10 publications

References 27 publications

Endoscopic Resection for Gastric Subepithelial Tumor with Backup Laparoscopic Surgery: Description of a Single-Center Experience

Endoscopic Resection for Gastric Subepithelial Tumor with Backup Laparoscopic Surgery: Description of a Single-Center Experience

Laparoscopic transgastric resection of gastric submucosal tumor located near the esophagogastric junction

Choice of LECS Procedure for Benign and Malignant Gastric Tumors

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