Intraoperative portable abdominal radiograph for tumor localization: a simple and accurate method for laparoscopic gastrectomy.
BACKGROUND
During laparoscopic gastrectomy, it is impossible to identify early gastric cancer (EGC) lesions; therefore, a precise localization technique is required. In this study, we evaluated a novel method of intraoperative portable abdominal radiograph for localization of EGC lesions after preoperative endoscopic clipping.


METHODS
A retrospective study of 80 patients who had undergone laparoscopic gastrectomies with our intraoperative abdominal radiographic method of tumor localization was performed. During preoperative endoscopy, endoscopic metal clips were applied just proximal to the tumor. A plain abdominal radiograph taken immediately after oral administration of effervescent agents was employed to select candidates for intraoperative localization. Intraoperative vessel clips were laparoscopically applied along the greater and lesser curvatures, and a portable abdominal radiograph was taken to identify the location of endoscopic clips relative to laparoscopic vessel clips.


RESULTS
In all patients, endoscopic clips were applied proximal to the lesion without complications. Both intraluminally and extraluminally placed clips were successfully detected by intraoperative portable abdominal radiograph in all patients. Mean ± standard deviation (SD) proximal margin length was 34.2 ± 20.2 mm. All patients had tumor-free resection margin.


CONCLUSIONS
Preoperative endoscopic clipping and intraoperative portable abdominal radiograph is an accurate and simple tumor localization method in laparoscopic gastrectomy.
Kim
Hyoung-Il
HI
Department of Surgery, Yonsei University College of Medicine, Seodaemun-gu, Seoul, 120-752, Korea.
Hyung
Woo Jin
WJ
Lee
Cho Rok
CR
Lim
Joon Seok
JS
An
Ji Yeong
JY
Cheong
Jae-Ho
JH
Choi
Seung Ho
SH
Noh
Sung Hoon
SH
D000328:Adult; D000368:Aged; D002245:Carbon Dioxide; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005763:Gastroenterostomy; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011300:Preoperative Care; D015641:Radiography, Interventional / Q000295:instrumentation*; D012189:Retrospective Studies; D012371:Robotics; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging*; D013525:Surgical Instruments
D002245:Carbon Dioxide