title: Novel method for hybrid endo-laparoscopic full-thickness gastric resection using laparoscopic transgastric suture passer device.
abstract: BACKGROUND
  Current surgical methods for partial gastric full-thickness resections (FTRs) are limited by long operative times and risk of gastric content spillage, especially for lesions located at the posterior wall. We propose a simplified hybrid approach to FTR with reduced risk of spillage.
  
  
  METHODS
  Resection margins were marked by endoscopic electrocautery to simulate a gastric lesion in the upper third of the posterior wall in eight pigs. A custom-made laparoscopic "suture passer" was made of a sharpened bendable dissecting forceps. Full-thickness sutures were alternatively passed from the serosa side with the suture passer through the gastric wall and grabbed endoluminally using an endoscopic grasper and vice versa. These transgastric sutures formed either a purse string (PS; n = 4) or a continuous horizontal mattress (HM; n = 4). Sutures were then fastened from the laparoscopic side, resulting in external outpouching of the lesion. The pouch was transected using 45-mm linear staplers. Operative time, resection margins, and number of staplers were evaluated.
  
  
  RESULTS
  The combined approach allowed one to precisely place the sutures around the pseudo lesions, despite the inflated stomach, and it included all target markings. PS and HM methods were similar regarding time for transgastric suture (780 s ± 219.1 s vs. 765 s ± 179.2 s, p = .885), resection margins (1.3 ± 1.0 cm vs. 0.8 ± 0.6 cm, p = .248), and number of staplers (3.8 ± 1.0 vs 3.3 ± 0.5, p = .405). Stapling time (600 s ± 189.7 s vs. 330 s ± 24.5 s, p = .028) was significantly shorter in the HM technique.
  
  
  CONCLUSIONS
  FTR with laparo-endoscopic transgastric suture application was feasible in the animal model. This technique allows one to achieve accurate resection margins with minimal risk of spillage.
authors.affiliation: Image-Guided Minimally Invasive Surgical Institute, IHU-Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France.|Department of Surgery, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Seong-Ho
authors.initials: SH
authors.lastname: Kong
authors.affiliation: Image-Guided Minimally Invasive Surgical Institute, IHU-Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France. michele.diana@ircad.fr.|Research Institute Against Cancer of the Digestive System (IRCAD), Strasbourg, France. michele.diana@ircad.fr.
authors.forename: Michele
authors.initials: M
authors.lastname: Diana
authors.affiliation: Research Institute Against Cancer of the Digestive System (IRCAD), Strasbourg, France.|Department of General Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yu-Yin
authors.initials: YY
authors.lastname: Liu
authors.affiliation: Image-Guided Minimally Invasive Surgical Institute, IHU-Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France.
authors.forename: Hyun-Jik
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Image-Guided Minimally Invasive Surgical Institute, IHU-Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France.
authors.forename: Andras
authors.initials: A
authors.lastname: Legner
authors.affiliation: Image-Guided Minimally Invasive Surgical Institute, IHU-Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France.
authors.forename: Renato
authors.initials: R
authors.lastname: Soares
authors.affiliation: Image-Guided Minimally Invasive Surgical Institute, IHU-Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France.
authors.forename: Lee
authors.initials: L
authors.lastname: Swanström
authors.affiliation: Research Institute Against Cancer of the Digestive System (IRCAD), Strasbourg, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Dallemagne
authors.affiliation: Department of Surgery, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Han-Kwang
authors.initials: HK
authors.lastname: Yang
authors.affiliation: Image-Guided Minimally Invasive Surgical Institute, IHU-Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France.|Research Institute Against Cancer of the Digestive System (IRCAD), Strasbourg, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Marescaux
mesh_terms: D000818:Animals; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005773:Gastroscopy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D023421:Models, Animal; D013274:Stomach Neoplasms / Q000601:surgery*; D034421:Sus scrofa; D013536:Suture Techniques; D013537:Sutures; D013552:Swine
keywords: Full-thickness resection; Gastric cancer; Hybrid laparo-endoscopic surgery