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Endoscopic Full-Thickness Resection Combined with Laparoscopic Surgery.

Chan Gyoo Kim1

  • 1Center for Gastric Cancer, National Cancer Center, Goyang, Korea.

Clinical Endoscopy
|January 15, 2018
PubMed
Summary

Laparoscopic and endoscopic cooperative surgery (LECS) and laparoscopy-assisted endoscopic full-thickness resection (LAEFR) offer safe and effective tumor removal. However, risks of cancer cell seeding and gastric juice spillage exist with these "cut first" methods.

Keywords:
Endoscopic full-thickness resectionLaparoscopic and endoscopic cooperation surgeryNon-exposed endoscopic wall-inversion surgeryNon-exposure simple suturing endoscopic full-thickness resection

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Minimally Invasive Surgery

Background:

  • Endoscopic full-thickness resection combined with laparoscopic surgery represents a novel approach to gastrointestinal tumor treatment.
  • Two primary techniques exist: 'Cut first and then suture' (e.g., LECS, LAEFR) and 'Suture first and then cut'.
  • Current 'cut first' methods demonstrate safety and efficacy but carry risks of tumor exposure and contamination.

Purpose of the Study:

  • To detail the advantages and limitations of novel endoscopic full-thickness resection techniques combined with laparoscopy.
  • To compare the 'Cut first and then suture' and 'Suture first and then cut' approaches.
  • To highlight potential complications associated with current minimally invasive gastrointestinal surgery.

Main Methods:

  • Review of existing literature on laparoscopic and endoscopic cooperative surgery (LECS) and laparoscopy-assisted endoscopic full-thickness resection (LAEFR).
  • Description of the 'Suture first and then cut' technique involving serosal suturing and subsequent endoscopic resection.
  • Analysis of the risks and benefits associated with each surgical approach.

Main Results:

  • Laparoscopic and endoscopic cooperative surgery (LECS) and laparoscopy-assisted endoscopic full-thickness resection (LAEFR) are safe and effective for tumor resection.
  • These 'cut first' techniques may expose the tumor and gastric mucosa to the peritoneal cavity, risking cancer cell seeding.
  • The 'Suture first and then cut' technique aims to mitigate these risks through inversion and endoscopic resection.

Conclusions:

  • Novel combined laparoscopic and endoscopic techniques offer promising solutions for gastrointestinal tumor resection.
  • Careful consideration of technique is necessary to minimize risks such as cancer cell seeding and peritoneal contamination.
  • The 'Suture first and then cut' method presents an alternative approach to address the limitations of current 'cut first' techniques.