Gastric lymphatic basin dissection for sentinel node biopsy using hybrid natural orifice transluminal endoscopic surgery (NOTES).
The aim of the present study was to describe a method of gastric lymphatic basin dissection for sentinel node biopsy using natural orifice transluminal endoscopic surgery with laparoscopic assistance (hybrid NOTES) in a porcine model. Lymph node dissection was performed in three healthy female domestic farm pigs (each around 40 kg) between October, 2007, and December, 2007. The pigs were administered a general anesthetic and laparoscopy-guided transvaginal colpotomy was performed. A two-channel endoscope was then inserted through the incision into the peritoneal cavity via the transvaginal route. An endoscope was inserted simultaneously into the mouth and indocyanine green solution was injected into the submucosal layer of the gastric wall at four sites. Dyed omentum and lymphatics were dissected using a laparoscopic dissector and the grasping forceps of a transvaginal endoscope. Lymphatics and omentum (mean 13.3 cm, range 8-20 cm) were removed transvaginally. The mean number of detected and resected sentinel nodes was 2.6 (range 1-4, diameter 2~12 mm). Sentinel lymphatic basin dissection was performed successfully and without intraoperative complications in all three cases. Hybrid NOTES is technically feasible, and this procedure may represent an alternative to laparoscopic sentinel lymph node dissection of the stomach.
Department of Surgery, Gyeongsang National University Hospital, Gyeongsang Institute of Health Sciences, Jinju, South Korea.
Sang-Ho
SH
Jeong
Young-Joon
YJ
Lee
Eun-Heun
EH
Lee
Soon-Tae
ST
Park
Sang-Kyung
SK
Choi
Soon-Chan
SC
Hong
Eun-Jung
EJ
Jung
Young-Tae
YT
Joo
Chi-Young
CY
Jeong
Woo-Song
WS
Ha
D000768:Anesthesia, General / Q000379:methods; D000818:Animals; D020884:Colpotomy / Q000379:methods; D019723:Endoscopes; D005260:Female; D007431:Intraoperative Complications / Q000517:prevention & control; D010535:Laparoscopy / Q000379:methods; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects / Q000379:methods*; D034421:Sus scrofa; D014621:Vagina