Partial gastrectomy using natural orifice translumenal endoscopic surgery (NOTES) for gastric submucosal tumors: early experience in humans
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Transvaginal endoscopic gastric surgery is one of the cutting edge procedures in the field of natural orifice translumenal endoscopic surgery (NOTES). Its feasibility has been shown sporadically in bariatric cases but not in oncologic conditions. The authors report their early experience with hybrid transvaginal NOTES gastrectomy for gastric submucosal tumors (SMTs).
Two female patients with SMTs in the distal stomach participated in this institutional review board (IRB)-approved study. Surgical indication was determined according to the National Comprehensive Cancer Network (NCCN) sarcoma guidelines, and the study adhered to the following oncologic principles: no direct handling of the lesion, full-thickness resection, and reasonable surgical margins. The study protocol required a minimum of two laparoscopic ports to ensure procedural safety and aforementioned oncologic appropriateness. Under laparoscopic guidance, a transvaginal route was created and secured with a 50-cm flexible overtube. A gastrointestinal endoscope was introduced, and the perigastric dissection was performed using an insulation-tipped diathermy knife (IT knife) and needle knife. This process was assisted with two laparoscopic graspers. After perigastric mobilization, the transvaginal endoscope was replaced with a digital stapling device, and partial gastrectomy was accomplished. The resected specimen was isolated and delivered through the vagina, and the vaginal wound was closed under direct vision. Outcomes measurements included surgical results, pain scoring, and clinical outcomes.
Both operations were completed successfully in compliance with the aforementioned oncologic principles. The operating time was 365 and 170 min, respectively. The estimated blood loss was negligible. A minilaparotomy for specimen delivery was successfully avoided in both cases. A minimal vaginal incision was added for one patient at retrieval. Postoperatively, both patients reported no pain and recovered rapidly. The final diagnosis was hemorrhagic lipoma and gastrointestinal stromal tumor (GIST), respectively.
Our initial experience with human transvaginal NOTES gastrectomy showed it to be feasible and safe for gastric SMTs. It is a complex but promising surgical alternative for female oncologic patients undergoing partial gastric resection.
- Nakajima K, Takahashi T, Souma Y, Shinzaki S, Yamada T, Yoshio T, Nishida T (2008) Transvaginal endoscopic partial gastrectomy in porcine models: the role of an extra endoscope for gastric control. Surg Endosc (Epub ahead of print)
- Ramos, AC, Zundel, N, Neto, MG, Maalouf, M (2008) Human hybrid NOTES transvaginal sleeve gastrectomy: initial experience. Surg Obes Relat Dis 4: pp. 660-663 CrossRef
- Madan, AK, Tichansky, DS, Khan, KA (2008) Natural orifice transluminal endoscopic gastric bypass performed in a cadaver. Obes Surg 18: pp. 1192-1199 CrossRef
- Nishimura, J, Nakajima, K, Omori, T, Takahashi, T, Nishitani, A, Ito, T, Nishida, T (2007) Surgical strategy for gastric gastrointestinal stromal tumors: laparoscopic vs open resection. Surg Endosc 21: pp. 875-878 CrossRef
- Takahashi, T, Nakajima, K, Nishitani, A, Souma, Y, Hirota, S, Sawa, Y, Nishida, T (2007) An enhanced risk-group stratification system for more practical prognostication of clinically malignant gastrointestinal stromal tumors. Int J Clin Oncol 12: pp. 369-374 CrossRef
- NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST): update of the NCCN clinical practice guidelines. J Natl Compr Cancer Netw 5: pp. S1-S29
- Nishida, T, Hirota, S, Yanagisawa, A, Sugino, Y, Minami, M, Yamamura, Y, Otani, Y, Shimada, Y, Takahashi, F, Kubota, T (2008) Clinical practice guidelines for gastrointestinal stromal tumor (GIST) in Japan: English version. Int J Clin Oncol 13: pp. 416-430 CrossRef
- Kitano, S, Tajiri, H, Yasuda, K, Ikdeda, K, Sumiyama, K, Nakajima, K, Saida, Y (2008) Current status and activity regarding natural orifice translumenal endoscopic surgery (NOTES) in Japan. Asian J Endosc Surg 1: pp. 7-10 CrossRef
- Ramos, AC, Murakami, A, Galvão Neto, M, Galvão, MS, Silva, AC, Canseco, EG, Moyses, Y (2008) NOTES transvaginal video-assisted cholecystectomy: first series. Endoscopy 40: pp. 572-575 CrossRef
- Gordts, S, Watrelot, A, Campo, R, Brosens, I (2001) Risk and outcome of bowel injury during transvaginal pelvic endoscopy. Fertil Steril 76: pp. 1238-1241 CrossRef
- Gordts, S, Puttemans, P, Gordts, S, Brosens, I, Campo, R (2005) Transvaginal laparoscopy. Best Pract Res Clin Obstet Gynaecol 19: pp. 757-767 CrossRef
- Nakajima, K, Lee, SW, Sonoda, T, Milsom, JW (2005) Intraoperative carbon dioxide colonoscopy: a safe insufflation alternative for locating colonic lesions during laparoscopic surgery. Surg Endosc 19: pp. 321-325 CrossRef
- Souma Y, Nakajima K, Takahashi T, Nishimura J, Fujiwara Y, Takiguchi S, Miyata H, Yamazaki M, Doki Y, Nishida T (2008) The role of intraoperative carbon dioxide insufflating upper gastrointestinal endoscopy during laparoscopic surgery. Surg Endosc (in press)
- Partial gastrectomy using natural orifice translumenal endoscopic surgery (NOTES) for gastric submucosal tumors: early experience in humans
Volume 23, Issue 12 , pp 2650-2655
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Department of Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
- 2. Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
- 3. Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan