title: First case of non-exposed endoscopic wall-inversion surgery with sentinel node basin dissection for early gastric cancer.
abstract: BACKGROUND
  Non-exposed endoscopic wall-inversion surgery (NEWS) is a novel technique of endoscopic full-thickness resection without transluminal access mainly designed to treat gastric cancer. Here, we report a successful case of NEWS with sentinel node basin dissection (SNBD) for early gastric cancer (EGC) with the risk of lymph node metastasis.
  
  
  METHODS
  A 55-year-old female patient with a 2-cm, diffuse-type intramucosal EGC with ulceration was referred to our hospital for a less invasive gastrectomy based on sentinel node navigation surgery. After obtaining informed consent, NEWS with SNBD was applied. After placing mucosal markings, indocyanine green solution was injected endoscopically into the submucosa around the lesion to examine sentinel nodes (SNs). The SN basin (the area of the left gastric artery), including three stained SNs(#3), was dissected, and an intraoperative pathological diagnosis confirmed that no metastasis had occurred. Subsequently, NEWS was performed for the primary lesion. Serosal markings were placed laparoscopically, submucosal injection was added endoscopically, and circumferential sero-muscular incision and suturing were performed laparoscopically, with the lesion inverted toward the inside of the stomach. Finally, the circumferential mucosal incision was performed, and the lesion was retrieved perorally.
  
  
  RESULTS
  The operation was finished in 270 min without complications. The patient was uneventfully discharged 10 days after the procedure. The final pathological diagnosis was coincident with the pre- and intraoperative assessment.
  
  
  CONCLUSIONS
  We demonstrated the feasibility and safety of NEWS with SNBD with a favorable result. This surgical concept is expected to become a promising, minimally invasive, function-preserving surgery to cure cases of EGC that are possibly node-positive.
authors.affiliation: Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, Tokyo, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Goto
authors.forename: Hiroya
authors.initials: H
authors.lastname: Takeuchi
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kawakubo
authors.forename: Motoki
authors.initials: M
authors.lastname: Sasaki
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Matsuda
authors.forename: Satoru
authors.initials: S
authors.lastname: Matsuda
authors.forename: Yu
authors.initials: Y
authors.lastname: Kigasawa
authors.forename: Yoshie
authors.initials: Y
authors.lastname: Kadota
authors.forename: Ai
authors.initials: A
authors.lastname: Fujimoto
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Ochiai
authors.forename: Joichiro
authors.initials: J
authors.lastname: Horii
authors.forename: Toshio
authors.initials: T
authors.lastname: Uraoka
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
authors.forename: Naohisa
authors.initials: N
authors.lastname: Yahagi
mesh_terms: D004724:Endoscopy; D005260:Female; D005743:Gastrectomy; D005773:Gastroscopy; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*
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