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Published on: April 17, 2020
Novel Clean End-to-End Anastomosis Method, Without Opening the Stomach Lumen, in Totally Laparoscopic or Robotic
Takashi Mitsui1, Kazuyuki Saito2, Yuhei Hakozaki2
1Department of Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan. mitsuitakashi3@gmail.com.
Purpose:
Intra-abdominal infection is a common postoperative complication of laparoscopic pylorus-preserving gastrectomies (PPGs). Many studies have reported that intra-abdominal infectious complications after gastrectomy adversely affect patient survival outcomes. To prevent gastric fluid leakage into the abdominal cavity, we developed a novel anastomosis method in which the stomach lumen is not opened (termed the non-opened clean end-to-end anastomosis method [NoCEAM]) and evaluated its feasibility.
Materials And Methods:
Subsequent to lymphadenectomy, the oral and anal resection lines were sutured using an intraoperative endoscope. After closing the stomach circumferentially with clips, the specimen was rolled outward like a "donut." We resected the specimen circumferentially using a linear stapler, and anastomosis was completed simultaneously. We examined the feasibility of this procedure ex vivo, using three porcine stomachs, and in vivo, using one pig. Subsequently, we applied the procedure to 13 consecutive patients with middle-third early gastric cancer utilizing laparotomic, laparoscopic, and robotic PPG.
Results:
NoCEAM was completed in all porcine models and human cases. In the human cases, the mean operation time (±standard deviation) was 279±51 minutes, and mean blood loss volume was 22±45 mL. The mean number of linear staples used was 5.06±0.76. None of the patients had complications, and all were discharged on the eighth postoperative. The serum total protein, serum albumin, and hemoglobin levels did not change significantly after surgery.
Conclusions:
NoCEAM is feasible and safe for performing totally laparoscopic or robotic PPG. It may reduce postoperative complications, such as intra-abdominal infections.
Insights
A novel non-opened clean end-to-end anastomosis method (NoCEAM) was developed to prevent complications after laparoscopic pylorus-preserving gastrectomies (PPGs). This technique proved feasible and safe in porcine and human studies, showing potential to reduce intra-abdominal infections.
Area of Science:
- Surgical Oncology
- Gastrointestinal Surgery
- Minimally Invasive Surgery
Background:
- Intra-abdominal infection is a frequent postoperative complication following laparoscopic pylorus-preserving gastrectomies (PPGs).
- Such infectious complications can negatively impact patient survival outcomes after gastrectomy.
- Preventing gastric fluid leakage is crucial for reducing postoperative morbidity.
Purpose of the Study:
- To introduce and assess the feasibility of a novel anastomosis technique, the non-opened clean end-to-end anastomosis method (NoCEAM).
- NoCEAM aims to prevent gastric fluid leakage into the abdominal cavity during PPG.
- To evaluate the safety and efficacy of NoCEAM in minimally invasive gastrectomy procedures.
Main Methods:
- The NoCEAM technique involves suturing resection lines with an intraoperative endoscope, circumferentially closing the stomach with clips, and performing resection and anastomosis with a linear stapler.
- Feasibility was initially tested ex vivo on porcine stomachs and in vivo on a pig.
- The procedure was subsequently applied to 13 patients undergoing laparoscopic, robotic, or laparotomic PPG for middle-third early gastric cancer.
Main Results:
- NoCEAM was successfully completed in all porcine and human subjects.
- In human cases, the average operative time was 279±51 minutes with a mean blood loss of 22±45 mL.
- No postoperative complications were observed in any patient, with all discharged on postoperative day 8; key serum protein and hemoglobin levels remained stable.
Conclusions:
- The non-opened clean end-to-end anastomosis method (NoCEAM) is a feasible and safe technique for laparoscopic and robotic pylorus-preserving gastrectomies.
- NoCEAM holds promise for reducing postoperative complications, particularly intra-abdominal infections, following gastrectomy.
- This novel method may improve patient outcomes and recovery after minimally invasive gastrectomy.
