title: Feasibility of the trans-umbilical route compared with the trans-oral route in gastric upper body endoscopic submucosal dissection: a porcine model.
abstract: BACKGROUND
  Total gastrectomy is performed for early gastric cancer in the upper body of the stomach because of the high complication rate of endoscopic submucosal dissection (ESD). The aims of the present animal study in pigs were to verify: (1) the feasibility of the trans-umbilical route compared with the trans-oral route in gastric upper body ESD; (2) the non-inferiority of single port laparoscopic lymph node dissection (LLND) compared with multiport LLND; and (3) the safety of 2-basin LLND (upper greater and lesser curvature).
  
  
  METHODS
  We separated the pigs (~40 kg each) into two groups: conventional and experimental (n = 5 per group). We performed ESD in the fundus and upper body anterior wall (UBAW) via the trans-oral route and multiport LLND in the conventional group, and via the trans-umbilical route and single port LLND in the experimental group.
  
  
  RESULTS
  The completion rates, tissue weights, and specimen diameters of both routes showed no statistical differences in either the fundus or the UBAW. The operative time was shorter with the trans-umbilical route than with the trans-oral route in both areas (p < 0.05). In LLND, there were no differences in surgical outcomes between the multiport and single port groups. Intraoperative perforation was seen in the trans-oral route group (n = 1). Delayed perforation was observed in 30 % of the ESD sites.
  
  
  CONCLUSIONS
  The trans-umbilical route is feasible and has lower complication rates than the trans-oral route in gastric upper body ESD. Additionally, single port LLND is not inferior to multiport LLND, and one-side-basin dissection is safer than two-side.
authors.affiliation: Department of Surgery, Gyeongsang National University, 90 Chilam-dong, Jinju, Gyeongsang South Province, 660-702, South Korea.
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Jeong
authors.forename: Ji-Ho
authors.initials: JH
authors.lastname: Park
authors.forename: Moon-Won
authors.initials: MW
authors.lastname: Yoo
authors.forename: Sang-Kyung
authors.initials: SK
authors.lastname: Choi
authors.forename: Soon-Chan
authors.initials: SC
authors.lastname: Hong
authors.forename: Eun-Jung
authors.initials: EJ
authors.lastname: Jung
authors.forename: Young-Tae
authors.initials: YT
authors.lastname: Ju
authors.forename: Chi-Young
authors.initials: CY
authors.lastname: Jeong
authors.forename: Woo-Song
authors.initials: WS
authors.lastname: Ha
authors.forename: Chang Yoon
authors.initials: CY
authors.lastname: Ha
authors.forename: Young-Joon
authors.initials: YJ
authors.lastname: Lee
mesh_terms: D000818:Animals; D004210:Dissection / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D009055:Mouth; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009374:Neoplasms, Experimental; D061646:Operative Time; D013274:Stomach Neoplasms / Q000601:surgery; D013552:Swine; D014472:Umbilicus
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