title: Non-exposed endoscopic wall-inversion surgery as a novel partial gastrectomy technique.
abstract: In gastric full-thickness resection employing both endoscopy and laparoscopy, intraabdominal contamination or even possibly tumor seeding is unavoidable as a result of iatrogenic perforation and the resultant spread of gastric juice. To minimize contamination and resected tissue volume, we developed a new technique without perforation termed non-exposed endoscopic wall-inversion surgery (NEWS), and present here the preliminary results. In a clinical observation cohort study, NEWS was attempted in six patients with gastric SMT to investigate the procedure, mortality, and morbidity. NEWS consists of several steps: marking around a tumor on the mucosal as well as the serosal surface, submucosal injection of sodium hyaluronate with indigo carmine dye, circumferential seromuscular dissection with suture closure under laparoscopy, and circumferential mucosubmucosal incision under gastric endoscopy. The resected specimen is then retrieved perorally. Perforation occurred as a result of misidentification and technical inadequacy in the first three patients. After modification of the devices, the entire procedure was successfully achieved in the latter three. There were no complications in any of our six cases. NEWS allows en bloc full-thickness resection, theoretically avoiding contamination and tumor dissemination into the peritoneal cavity.
authors: Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, mitsuitakashi3@gmail.com.
authors: Takashi
authors: T
authors: Mitsui
authors: Keiko
authors: K
authors: Niimi
authors: Hiroharu
authors: H
authors: Yamashita
authors: Osamu
authors: O
authors: Goto
authors: Susumu
authors: S
authors: Aikou
authors: Fumihiko
authors: F
authors: Hatao
authors: Ikuo
authors: I
authors: Wada
authors: Nobuyuki
authors: N
authors: Shimizu
authors: Mitsuhiro
authors: M
authors: Fujishiro
authors: Kazuhiko
authors: K
authors: Koike
authors: Yasuyuki
authors: Y
authors: Seto
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004210:Dissection / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005753:Gastric Mucosa / Q000473:pathology; D046152:Gastrointestinal Stromal Tumors / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
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