Novel Clean End-to-End Anastomosis Method, Without Opening the Stomach Lumen, in Totally Laparoscopic or Robotic Pylorus-Preserving Gastrectomy.

IF 3.2 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Journal of Gastric Cancer Pub Date : 2023-10-01 DOI:10.5230/jgc.2023.23.e33
Takashi Mitsui, Kazuyuki Saito, Yuhei Hakozaki, Yoshiyuki Miwa, Takuji Noro, Emiko Takeshita, Taizen Urahashi, Yasuyuki Seto, Takashi Okuyama, Hideyuki Yoshitomi
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Abstract

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.

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在完全腹腔镜或机器人保胃胃切除术中,无需打开胃腔的新型端到端清洁吻合方法。
目的:腹腔感染是腹腔镜保幽门胃切除术(PPG)常见的术后并发症。许多研究报道,胃切除术后腹腔内感染性并发症会对患者的生存结果产生不利影响。为了防止胃液漏入腹腔,我们开发了一种不开放胃腔的新型吻合方法(称为非开放式端到端清洁吻合方法[NoCEAM]),并评估了其可行性。材料和方法:淋巴结切除术后,使用术中内窥镜缝合口腔和肛门切除线。在用夹子沿圆周闭合胃后,将标本像“甜甜圈”一样向外滚动。我们用线性缝合器沿圆周切除标本,同时完成吻合。我们使用三个猪胃在体外和使用一只猪在体内检查了该程序的可行性。随后,我们利用腹腔镜、腹腔镜和机器人PPG将该程序应用于连续13例中晚期癌症患者。结果:所有猪模型和人类病例均完成了NoCEAM。在人类病例中,平均手术时间(±标准差)为279±51分钟,平均失血量为22±45 mL。使用的线性吻合钉的平均数量为5.06±0.76。所有患者均无并发症,术后第8天全部出院。手术后血清总蛋白、血清白蛋白和血红蛋白水平没有显著变化。结论:NoCEAM用于全腹腔镜或机器人PPG是可行且安全的。它可以减少术后并发症,如腹腔内感染。
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来源期刊
Journal of Gastric Cancer
Journal of Gastric Cancer Biochemistry, Genetics and Molecular Biology-Cancer Research
CiteScore
4.30
自引率
12.00%
发文量
36
期刊介绍: The Journal of Gastric Cancer (J Gastric Cancer) is an international peer-reviewed journal. Each issue carries high quality clinical and translational researches on gastric neoplasms. Editorial Board of J Gastric Cancer publishes original articles on pathophysiology, molecular oncology, diagnosis, treatment, and prevention of gastric cancer as well as articles on dietary control and improving the quality of life for gastric cancer patients. J Gastric Cancer includes case reports, review articles, how I do it articles, editorials, and letters to the editor.
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