title: Laparoscopic intragastric full-thickness excision (LIFE) of posterior gastric lesions under flexible endoscopic control--a feasibility study.
abstract: BACKGROUND
  We have developed a new technique for treatment of intramucosal carcinoma which exceeds the standard indication for endoscopic mucosal resection and carcinoma invading the submucosa without lymph node metastasis that are located in the posterior wall of the stomach, which we refer to as laparoscopic intragastric full-thickness excision (LIFE) under flexible endoscopic control.
  
  
  METHODS
  Three pigs were used for the study. Three trocars were used. The first trocar (trocar # 1) was placed in the subumbilical region to introduce the videoscope, whereas the second and third trocars (trocar # 2 and trocar # 3) were punctured percutaneously into the abdominal cavity. A straight needle with 3-0 silk suture was attached to a T-bar on the wire side and inserted into the abdominal cavity. An area adjacent to the lesion in the posterior wall of the stomach was pierced by the straight needle, which was then pulled into the stomach using the forceps of the endoscope. The T-bar, after being passed through the abdominal wall, was fixed outside the gastric wall, and trocar # 3 was repositioned in the stomach by the percutaneous transgastric route. The posterior wall of the stomach was pulled inward by the T-bar, and the lesion was removed by several excisions with laparoscopic stapling devices inserted through trocar # 3; extraction of the specimen was achieved through trocar # 3. The gastrotomy site was suture-closed using instruments positioned through trocar # 2 and trocar # 3 under laparoscopy.
  
  
  CONCLUSIONS
  Based on a feasibility study in pigs, the LIFE procedure can be performed for lesions of the posterior wall of the stomach.
authors.affiliation: Department of Surgery, Daisan Hospital, The Jikei University School of Medicine, 4-11-1, Izumihon-cho, Komae-si, Tokyo, 201-8601, Japan. hoya@jikei.ac.jp
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Hoya
authors.forename: Makoto
authors.initials: M
authors.lastname: Yamashita
authors.forename: Takuya
authors.initials: T
authors.lastname: Inagaki
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D000818:Animals; D004867:Equipment Design; D005240:Feasibility Studies; D005773:Gastroscopy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D009361:Neoplasm Invasiveness; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013552:Swine; D016896:Treatment Outcome