Original article

Surgical Endoscopy And Other Interventional Techniques

, Volume 19, Issue 10, pp 1353-1357

First online:

Intraoperative tumor localization using laparoscopic ultrasonography in laparoscopic–assisted gastrectomy

  • W. J. HyungAffiliated withDepartment of Surgery, College of Medicine, Yonsei UniversityCancer Metastasis Research Center, College of Medicine, Yonsei University
  • , J. S. LimAffiliated withDepartment of Diagnostic Radiology, College of Medicine, Yonsei University
  • , J. H. CheongAffiliated withDepartment of Surgery, College of Medicine, Yonsei UniversityCancer Metastasis Research Center, College of Medicine, Yonsei University
  • , J. KimAffiliated withDepartment of Surgery, College of Medicine, Yonsei UniversityCancer Metastasis Research Center, College of Medicine, Yonsei University
  • , S. H. ChoiAffiliated withDepartment of Surgery, College of Medicine, Yonsei University
  • , S. Y. SongAffiliated withDepartment of Internal Medicine, College of Medicine, Yonsei UniversityBrain Korea 21 Project for Medical Science, College of Medicine, Yonsei University
  • , S. H. NohAffiliated withDepartment of Surgery, College of Medicine, Yonsei UniversityCancer Metastasis Research Center, College of Medicine, Yonsei UniversityBrain Korea 21 Project for Medical Science, College of Medicine, Yonsei University Email author 

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Abstract

Background

During laparoscopic-assisted gastrectomy, it is impossible to identify early gastric cancer (EGC) lesions; therefore, a precise localization technique is needed. In this study, we used laparoscopic ultrasonography (LUS) after endoscopic clipping as a method of localizing EGC and evaluated the effectiveness of this method.

Methods

A prospective study of 17 patients who had undergone laparoscopic—assisted gastrectomy was performed. Three endoscopic clips were applied just proximal to the tumor during the preoperative endoscopy. The applied clips were detected from the serosal side of the stomach using LUS. The serosal surface of the lesion was marked with dye.

Results

In all patients, endoscopic clips were applied proximal to the lesion without complications, and the applied clips were confirmed by plain abdominal radiography. The clips were successfully detected by LUS in all patients. In the resected specimen, the serosal surface, marked with dye, was always just above the clips in the anterior wall or on the anterior wall opposite the clips applied in the posterior wall. The mean detection time was 4.7 min (range, 2–8). With this procedure, two patients underwent total gastrectomy and 15 patients underwent distal subtotal gastrectomy with gastroduodenostomy or gastrojejunostomy. Histological examination confirmed that the resection margins were tumor free in all patients. There was no operative morbidity related to the LUS procedure.

Conclusions

Using LUS to detect endoscopic clips is an easy, safe, and accurate method to localize EGC lesions in laparoscopic-assisted gastrectomy.

Keywords

Tumor localization Laparoscopic Ultrasonography Laparoscopic-assisted gastrectomy Early gastric cancer