Surgical Endoscopy

, Volume 32, Issue 11, pp 4681–4687 | Cite as

Laparoscopic subtotal gastrectomy with a new marking technique, endoscopic cautery marking: preservation of the stomach in patients with upper early gastric cancer

  • Satoshi Kamiya
  • Manabu OhashiEmail author
  • Satoshi Ida
  • Koshi Kumagai
  • Souya Nunobe
  • Takeshi Sano
  • Naoki Hiki
Dynamic Manuscript



Laparoscopic subtotal gastrectomy (LsTG) has several advantages, including technical safety and preservation of postoperative function, compared with total or proximal gastrectomy for early gastric cancer. However, LsTG has some technical issues with respect to achieving a safe resection margin and patency in patients with lesions close to the cardia or fornix. When LsTG is performed for lesions located rather close to the cardia or fornix, conventional marking clips can physically hinder transection by an endoscopic linear stapler. Additionally, tracing the tumor boundary to create a precise resection line is difficult. To resolve these issues, we introduced a new marking technique called endoscopic cautery marking (ECM) involving the creation of small cauterized spots.


Of 791 patients who underwent laparoscopic gastrectomy from 2015 to 2017, 16 underwent LsTG with ECM. Before surgery, ECM was performed and the pathological tumor boundary was traced according to preoperative biopsies. Under intraoperative endoscopic guidance, we divided the stomach with an endoscopic linear stapler on the proximal side of the ECM site and examined the stump by pathological frozen section analysis to confirm the absence of cancer.


The median length of the endoscopically measured distance from the esophagogastric junction to the tumor was 30.0 mm (range 15–40 mm), and the median pathological proximal margin was 11.5 mm (range 0–26 mm). Although the ECM site was completely resected in all patients, frozen section analysis showed a positive margin in one lesion, which had an unclear tumor boundary due to gastritis. For this patient, we converted the procedure to laparoscopic completion gastrectomy. No severe complications or recurrences occurred.


LsTG with ECM was technically feasible, and short-term outcomes were acceptable in this preliminary study. Further experience and investigations are imperative to verify the oncological and functional implications of LsTG with ECM.


Gastric cancer Minimally invasive surgery Preservation Surgical diagnostic technique Gastrectomy Surgical margin 


Compliance with ethical standards


Drs. Satoshi Kamiya, Manabu Ohashi, Naoki Hiki, Satoshi Ida, Koshi Kumagai, Souya Nunobe, and Takeshi Sano have no conflict of interest or financial ties to disclose.

Supplementary material

Supplementary Video 1 (MP4 252243 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Satoshi Kamiya
    • 1
  • Manabu Ohashi
    • 1
    Email author
  • Satoshi Ida
    • 1
  • Koshi Kumagai
    • 1
  • Souya Nunobe
    • 1
  • Takeshi Sano
    • 1
  • Naoki Hiki
    • 1
  1. 1.Department of Gastroenterological SurgeryCancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan

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