title: Simple and reliable method for tumor localization during totally laparoscopic gastrectomy: intraoperative laparoscopic ultrasonography combined with tattooing.
abstract: We have developed a new method to localize a tumor during totally laparoscopic gastrectomy that uses intraoperative laparoscopic ultrasonography combined with preoperative clipping and tattooing. One or 2 days before the surgery, endoscopic clipping was performed just proximal to the tumor, followed by tattooing with India ink at the clipping site. Examination by intraoperative laparoscopic ultrasonography was performed at the tattooed site to detect the clips. The resection line of the stomach was determined with use of the detected clips as a marker of the proximal margin of the tumor. This method was attempted in 14 patients who underwent totally laparoscopic gastrectomy, and the clips were successfully identified in all patients. The clips were visualized as several layers of a hyperechoic bar, which was termed a "ladder sign." The mean time from insertion of the laparoscopic probe to identification of the clips was 2 min. The ladder sign is an important finding in this method.
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou, Chuo-ku, Kobe, 650-0017, Japan. tmatsuda@med.kobe-u.ac.jp.
authors.forename: Takeru
authors.initials: T
authors.lastname: Matsuda
authors.affiliation: Department of Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Iwasaki
authors.affiliation: Department of Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan.
authors.forename: Kenro
authors.initials: K
authors.lastname: Hirata
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Tsugawa
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Sugita
authors.affiliation: Department of Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan.
authors.forename: Sonoko
authors.initials: S
authors.lastname: Ishida
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Kanaji
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kakeji
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019160:Endosonography / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D013653:Tattooing / Q000379:methods*
keywords: Intraoperative laparoscopic ultrasonography; Ladder sign; Totally laparoscopic gastrectomy; Tumor localization