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Surgical Endoscopy

, Volume 25, Issue 3, pp 958–963 | Cite as

Intraoperative portable abdominal radiograph for tumor localization: a simple and accurate method for laparoscopic gastrectomy

  • Hyoung-Il Kim
  • Woo Jin HyungEmail author
  • Cho Rok Lee
  • Joon Seok Lim
  • Ji Yeong An
  • Jae-Ho Cheong
  • Seung Ho Choi
  • Sung Hoon Noh
Technique

Abstract

Background

During laparoscopic gastrectomy, it is impossible to identify early gastric cancer (EGC) lesions; therefore, a precise localization technique is required. In this study, we evaluated a novel method of intraoperative portable abdominal radiograph for localization of EGC lesions after preoperative endoscopic clipping.

Methods

A retrospective study of 80 patients who had undergone laparoscopic gastrectomies with our intraoperative abdominal radiographic method of tumor localization was performed. During preoperative endoscopy, endoscopic metal clips were applied just proximal to the tumor. A plain abdominal radiograph taken immediately after oral administration of effervescent agents was employed to select candidates for intraoperative localization. Intraoperative vessel clips were laparoscopically applied along the greater and lesser curvatures, and a portable abdominal radiograph was taken to identify the location of endoscopic clips relative to laparoscopic vessel clips.

Results

In all patients, endoscopic clips were applied proximal to the lesion without complications. Both intraluminally and extraluminally placed clips were successfully detected by intraoperative portable abdominal radiograph in all patients. Mean ± standard deviation (SD) proximal margin length was 34.2 ± 20.2 mm. All patients had tumor-free resection margin.

Conclusions

Preoperative endoscopic clipping and intraoperative portable abdominal radiograph is an accurate and simple tumor localization method in laparoscopic gastrectomy.

Keywords

Stomach neoplasms Laparoscopy Abdominal radiograph Gastrectomy Endoscopy 

Notes

Disclosures

Authors Hyoung-Il Kim, Woo Jin Hyung, Cho Rok Lee, Joon Seok Lim, Ji Yeong An, Jae-Ho Cheong, Seung Ho Choi, and Sung Hoon Noh have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Ryu KW, Lee JH, Choi IJ, Bae JM (2003) Preoperative endoscopic clipping: localizing technique of early gastric cancer. J Surg Oncol 82:75–77PubMedCrossRefGoogle Scholar
  2. 2.
    Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245:68–72PubMedCrossRefGoogle Scholar
  3. 3.
    Noh SH, Hyung WJ, Cheong JH (2005) Minimally invasive treatment for gastric cancer: approaches and selection process. J Surg Oncol 90:188–193; discussion 193-184PubMedCrossRefGoogle Scholar
  4. 4.
    Kitano S, Yasuda K, Shiraishi N (2006) Laparoscopic surgical resection for early gastric cancer. Eur J Gastroenterol Hepatol 18:855–861PubMedCrossRefGoogle Scholar
  5. 5.
    Ohgami M, Otani Y, Kumai K, Kubota T, Kim YI, Kitajima M (1999) Curative laparoscopic surgery for early gastric cancer: five years experience. World J Surg 23:187–192 discussion 192-183PubMedCrossRefGoogle Scholar
  6. 6.
    Park DJ, Lee HJ, Kim SG, Jung HC, Song IS, Lee KU, Choe KJ, Yang HK (2005) Intraoperative gastroscopy for gastric surgery. Surg Endosc 19:1358–1361PubMedCrossRefGoogle Scholar
  7. 7.
    Hyung WJ, Lim JS, Cheong JH, Kim J, Choi SH, Song SY, Noh SH (2005) Intraoperative tumor localization using laparoscopic ultrasonography in laparoscopic-assisted gastrectomy. Surg Endosc 19:1353–1357PubMedCrossRefGoogle Scholar
  8. 8.
    Beretvas RI, Ponsky J (2001) Endoscopic marking: an adjunct to laparoscopic gastrointestinal surgery. Surg Endosc 15:1202–1203PubMedCrossRefGoogle Scholar
  9. 9.
    Nagata K, Endo S, Tatsukawa K, Kudo SE (2008) Intraoperative fluoroscopy vs. intraoperative laparoscopic ultrasonography for early colorectal cancer localization in laparoscopic surgery. Surg Endosc 22:379–385PubMedCrossRefGoogle Scholar
  10. 10.
    Kim HJ, Kim AY, Oh ST, Kim JS, Kim KW, Kim PN, Lee MG, Ha HK (2005) Gastric cancer staging at multi-detector row CT gastrography: comparison of transverse and volumetric CT scanning. Radiology 236:879–885PubMedCrossRefGoogle Scholar
  11. 11.
    Agha FP, Trenkner SW, Woolsey EJ, Hayes D (1985) Comparison of two effervescent agents for double-contrast upper gastrointestinal tract radiography. Radiology 157:533–534PubMedGoogle Scholar
  12. 12.
    Japanese Gastric Cancer A (1998) Japanese classification of gastric carcinoma, 2nd English edition. Gastric Cancer 1:10–24Google Scholar
  13. 13.
    Song J, Oh SJ, Kang WH, Hyung WJ, Choi SH, Noh SH (2009) Robot-assisted gastrectomy with lymph node dissection for gastric cancer: lessons learned from an initial 100 consecutive procedures. Ann Surg 249:927–932PubMedCrossRefGoogle Scholar
  14. 14.
    Davies J, Johnston D, Sue-Ling H, Young S, May J, Griffith J, Miller G, Martin I (1998) Total or subtotal gastrectomy for gastric carcinoma? A study of quality of life. World J Surg 22:1048–1055PubMedCrossRefGoogle Scholar
  15. 15.
    Hornig D, Kuhn H, Stadelmann O, Botticher R (1983) Phlegmonous gastritis after Indian ink marking. Endoscopy 15:266–269PubMedCrossRefGoogle Scholar
  16. 16.
    Montorsi M, Opocher E, Santambrogio R, Bianchi P, Faranda C, Arcidiacono P, Passoni GR, Cosentino F (1999) Original technique for small colorectal tumor localization during laparoscopic surgery. Dis Colon Rectum 42:819–822PubMedCrossRefGoogle Scholar
  17. 17.
    Jensen DM, Machicado GA (2009) Hemoclipping of chronic canine ulcers: a randomized, prospective study of initial deployment success, clip retention rates, and ulcer healing. Gastrointest Endosc 70:969–975PubMedCrossRefGoogle Scholar
  18. 18.
    Raju GS, Gajula L (2004) Endoclips for GI endoscopy. Gastrointest Endosc 59:267–279PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Hyoung-Il Kim
    • 1
  • Woo Jin Hyung
    • 1
    • 2
    • 3
    Email author
  • Cho Rok Lee
    • 1
  • Joon Seok Lim
    • 4
  • Ji Yeong An
    • 1
  • Jae-Ho Cheong
    • 1
  • Seung Ho Choi
    • 1
  • Sung Hoon Noh
    • 1
    • 2
    • 3
    • 5
  1. 1.Department of SurgeryYonsei University College of MedicineSeoulKorea
  2. 2.Institute of GastroenterologyYonsei University College of MedicineSeoulKorea
  3. 3.Cancer Metastasis Research CenterYonsei University College of MedicineSeoulKorea
  4. 4.Department of RadiologyYonsei University College of MedicineSeoulKorea
  5. 5.Brain Korea 21 Project for Medical ScienceYonsei University College of MedicineSeoulKorea

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