title: Nonexposure endolaparoscopic full-thickness resection with simple suturing technique.
abstract: OBJECTIVE
  Current endoscopic full-thickness resection (EFTR) methods are limited by their transmural communication and exposure of tumor to the peritoneum. The aim of this study was to test the feasibility of a new resection technique that does not expose the mucosa to the peritoneum, although it involves an easy and secure suture method, which could be applied in the clinical setting.
  
  
  METHODS
  The nonexposure endolaparoscopic full-thickness resection with simple suturing technique was performed in four pigs. This new technique includes the steps of laparoscopic seromuscular suturing, which results in inversion of the stomach wall; EFTR of the inverted stomach wall from inside the stomach; and finally, endoscopic mucosal suturing with endoloops and clips.
  
  
  RESULTS
  En bloc and complete resections were achieved without adverse events in all pigs. The mean (± standard deviation) operation time was 137.0 ± 28.2 minutes. All pigs survived with no clinical evidence of illness until euthanasia. Gross and microscopic examination of the resection site showed healing without evidence of leakage or infection.
  
  
  CONCLUSIONS
  The nonexposure endolaparoscopic full-thickness resection with simple suturing technique was feasible in an animal model.
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Chan Gyoo
authors.initials: CG
authors.lastname: Kim
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Hong Man
authors.initials: HM
authors.lastname: Yoon
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Jong Yeul
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Soo-Jeong
authors.initials: SJ
authors.lastname: Cho
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Myeong-Cherl
authors.initials: MC
authors.lastname: Kook
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Bang Wool
authors.initials: BW
authors.lastname: Eom
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Keun Won
authors.initials: KW
authors.lastname: Ryu
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Young-Woo
authors.initials: YW
authors.lastname: Kim
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Il Ju
authors.initials: IJ
authors.lastname: Choi
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004867:Equipment Design; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery; D005773:Gastroscopy / Q000295:instrumentation / Q000379:methods; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013536:Suture Techniques; D013552:Swine; D016896:Treatment Outcome