title: Accurate, safe, and rapid method of intraoperative tumor identification for totally laparoscopic distal gastrectomy: injection of mixed fluid of sodium hyaluronate and patent blue.
abstract: BACKGROUND
  In totally laparoscopic distal gastrectomy, determining the resection line with safe proximal margins is often difficult, particularly for tumors located in a relatively upper area. This is because, in contrast to open surgery, identifying lesions by palpating or opening the stomach is essentially impossible. This study introduces a useful method of tumor identification that is accurate, safe, and rapid.
  
  
  METHODS
  On the operation day, after inducing general anesthesia, a mixture of sodium hyaluronate and patent blue is injected into the submucosal layer of the proximal margin. When resecting stomach, all marker spots should be on the resected side. In all cases, the proximal margin is examined histologically by using frozen sections during the operation.
  
  
  RESULTS
  From October 2009 to September 2011, a prospective study that evaluated this method was performed. A total of 34 patients who underwent totally laparoscopic distal gastrectomy were enrolled in this study. Approximately 5 min was required to complete the procedure. Proximal margins were negative in all cases, and the mean ± standard deviation length of the proximal margin was 23.5 ± 12.8 mm. No side effects, such as allergy, were encountered.
  
  
  CONCLUSIONS
  As a method of tumor identification for totally laparoscopic distal gastrectomy, this procedure appears accurate, safe, and rapid.
authors.affiliation: Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan, m-nakagawa.srg2@tmd.ac.jp.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Nakagawa
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Ehara
authors.forename: Masaki
authors.initials: M
authors.lastname: Ueno
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Tanaka
authors.forename: Sachiko
authors.initials: S
authors.lastname: Kaida
authors.forename: Harushi
authors.initials: H
authors.lastname: Udagawa
mesh_terms: D004396:Coloring Agents / Q000008:administration & dosage; D004338:Drug Combinations; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D015552:Injections, Intralesional; D007432:Intraoperative Period; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012394:Rosaniline Dyes / Q000008:administration & dosage; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D055675:Viscosupplements / Q000008:administration & dosage
chemical_list: D004396:Coloring Agents; D004338:Drug Combinations; D012394:Rosaniline Dyes; D055675:Viscosupplements; D006820:Hyaluronic Acid; C008769:sulfan blue