This study was supported by a grant from the National R&amp;D Program for Cancer Control, Ministry of Health &amp; Welfare, Republic of Korea (1320270).

Etik Beyanı: İnsan denekleri Bu prosedür Ajou Üniversitesi Hastanesi Kurumsal Değerlendirme Kurulu (KİK) tarafından onaylanmıştır. Cerrahi 1. Hazırlık <ol><li> ameliyat öncesi gece yarısından sonra ağızdan hiçbir şey, yumuşak bir diyet ameliyattan bir gün önce izin verin. Not: Ameliyat öncesi ve esnasında nazogastrik tüp sokmayın. Bu protokol mide söndürmek için herhangi bir tüp kullanmaz. mide laparoskopik cerrahinin sınırlı görünümü neden şişmiş ise Bunun yerine, içi mide gazı laparoskopik ponksiyon iğnesi ile aspire edilebilir. </li><li> ameliyat masasında hasta yerleştirdikten sonra, indüksiyon ajanı (Tiopental Sodyum, 100 mg) yönetmek. </li><li> kas gevşetici intravenöz enjeksiyon (Rocuronium bromür, 1.0 mg / kg) sonra ağız boşluğu yoluyla endotrakeal tüpü yerleştirin. </li><li> sonra th izlemek, endotrakeal tüp yoluyla - anestezik gaz (% 3 Sevofluran, 2) BaşlangıçAmeliyat sırasında stabilite için e hasta. </li></ol> İntraoperatif gastroskopi öncesi 2. Cerrahi Prosedür <ol><li> ters Trendelenburg pozisyonuna hastayı ve hastanın sağ tarafında durmak. </li><li> Göbek altı alanda 10 mm kesi yapmak ve karın boşluğuna ilk trokar yerleştirin. </li><li> 18 mm Hg - en kısa sürede trokar takılı olarak, 15 pneumoperitoneumun oluşturmak için trokar ile karbondioksit gaz tüpü takın. </li><li> trokar içinden sert 30 ° Laparoskop takın ve laparoskopik sistemi ile bağlantılı bir monitörde karın boşluğuna keşfetmek. </li><li> çalışma bağlantı noktaları gibi 4 ek trokarları (bir 12 mm ve üç 5 mm) yerleştirin. göbek sağ üst tarafında 12 mm Noktalayıcıyı yerleştirin. göbek ve karın hem üst dış kadranda sol üst tarafındaki diğer üç 5 mm trokarları yerleştirin. </li><li> Inferi doğru transvers kolon boyunca gastrokolik ligament teşrihveya dalak kutup ultrasonik endoskopik makas kullanarak. </li><li> Sol gastroepiploik arter bağlanır ve laparoskopik klip ile kökünde dalak gemilerden menşeli ven ve pankreas kuyruk üstün sınırının maruz kaldıktan sonra, ultrasonik endoskopik makas kullanarak rezeke. </li><li> ultrasonik endoskopik makas kullanarak, pilor ve pankreas başının etrafında peripyloric lenf düğümleri incelemek ve kökenlerine doğru gastroepiploik gemileri rezeksiyonu. </li><li> Duodenum birinci kısmının rezeksiyonu önce gastroskopik prosedürü (Şekil 1) sırasında ince bağırsağın içine gaz geçişini önlemek için laparoskopik kelepçe ile duodenum kelepçe. </li></ol> 3. İntraoperatif Gastroskopi <ol><li> intraoperatif gastroskopi gerçekleştirmek için hastanın başının sol tarafına hareket ettirin. </li><li> İntraoperatif gastroskopi sırasında diş ve diş etleri korumak için bir sakız kalkanı takın. </li><li> hea çeviringastroskopi sokulması için sol tarafına, hastanın, d. </li><li> Ağız boşluğu, yemek borusu, mide mukozası yaralanmasını önlemek için, dikkatli bir şekilde ağız ve yemek borusu yoluyla mideye gastroskopi yerleştirin. </li><li> Birincil lezyonu bulmak gastroskopi ile gaz enjekte edilerek mide insuflasyon. Not: Çoğu gastroscopes işlem sırasında barsak içine gaz enjekte etmek, belirli bir düğme var. </li><li> Mesafe proksimal mide kurtarmak için çok kısa olması durumunda (daha önce açıklandığı gibi) (Şekil 2) tümörün proksimal marjı ve gastroskopi üzerinde işaretlenmiş ölçek kullanılarak özofagogastrik kavşağı arasındaki mesafeyi yaklaştığı ve total gastrektomi gerçekleştirin. 10 </li><li> total gastrektomi gerekli değilse, gastroskopi küçük bir delikten bir endoskopik enjektörü yerleştirin ve 2 enjekte - 3 cm prox - bir alanda 2 bir endoskopik enjektör kullanılarak mide duvarına çivit karmin 3 ccTümör kenardan minimal-, intra kaçınarak veya ekstralüminal kaçağı (Şekil 3A). <ol><li> iğne ile mide duvarında delik açılmasını önlemek için eğik mide duvarı içine enjektör iğne takın. Buna ek olarak, enjeksiyon sırasında intraluminal sızıntı tespit etmek çok yavaş indigo karmin enjekte. </li></ol></li><li> boya enjeksiyonundan sonra, gastroskopi ile aspire enflasyon gaz laparoskopik prosedür kolaylaştırmak için. Not: Çoğu gastroscopes işlem sırasında enflasyon gazı aspire için belirli bir düğme var. </li></ol> İntraoperatif gastroskopi sonra 4. Prosedür <ol><li> gastroskopik işlemden sonra hastanın sağ tarafına dönün. </li><li> Laparoskopik görünümünde, mavi boya (Şekil 3B) serozal boyama belirleyerek tümör yakın kısmı teyit etmektedir. </li><li> yeniden tümörün katılımını kaçınarak, endoskopik klip ile rezeke edilecek lekeli kısmı işaretleyinbölümü marjı (Şekil 4A). Not: 5 içinde bu işlemi gerçekleştirmeden tavsiye - ameliyat başladıktan sonra boya bazen sonraki işlemler sırasında dışarı yıkanabilir, çünkü 10 dakika. </li><li> boya serozaya tespit edilemezse, hemen gastroskopik görüş altında boya yeniden enjekte edilir. </li></ol> İntraoperatif gastroskopi sonra 5. Prosedür <ol><li> Duodenum rezeke ve Japon tedavi kılavuzlarına göre lenf nodu diseksiyonu için diğer prosedürleri gerçekleştirmek. 11 </li><li> lenf nodu diseksiyonu sonra, 2 endoskopik tel zımba kullanılarak, işaretleme klibi rehberliğinde tümör marjı, gelen uygun bir yerde en az 3 cm proksimalinde de mide rezeksiyonu. </li><li> En kısa sürede uzak mide rezeke gibi, endoskopik torbaya örnek yerleştirin ve 2 ile karın boşluğundan kılma - Göbek altı trokar sitenin 3 cm uzantısı. </li><li> proksimal marjı doku gönderintraoperatif histolojik değerlendirme için patoloji. </li><li> Rezeke midenin proksimal kısmında tümör serbest doku onaylanmasından sonra, kalan mide ve intrakorporeal doğrusal zımbalar (Şekil 4B) ile proksimal jejunum arasında bir anastomoz yaparlar. </li></ol>

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The authors have no conflicts of interest or financial ties to disclose.

Bu protokol, biz doğru ve güvenilir mide orta üçte tümör konumunu belirlemek için ameliyat gastroskopi için bir prosedür tanıttı. Biz başarıyla intraoperatif gastroskopi bulgularına dayanarak distal subtotal gastrektomi gerçekleştirmek başardık. Bugüne kadar, çeşitli yöntemler laparoskopik görünümünde erken evre mide kanserinin yerini belirlemek için uygulanmıştır. En yaygın yöntemler preoperatif gastroskopik kırpma kullanılan ve cerrahlar laparoskopik ultra...

Laparoskopik cerrahi Kore ve Japonya da dahil olmak üzere Doğu Asya ülkelerinde, erken mide kanseri tercih edilen tedavi haline gelmiştir. 1 Bu cerrahinin avantajı iyi erken evre mide kanserinin (EGC) için çeşitli klinik çalışmalarda ortaya konmuştur. 2-4 Çoğu arasında bu çalışmalarda işlemler laparoskopi ile gerçekleştirilmiştir, ancak tümör yerin belirlenmesi, primer tümörün dahil mide, ve yeniden rezeksiyonu minilaparotomi yoluyla gerçekleştirilmiştir. Bu nedenle, cerrahi minilaparotomi &quot;gastrektomi laparoskopi yardımlı.&quot; Etiketli olmuştur gerektiren Ancak son zamanlarda, cerrahi işlemler hastaların yaşam postoperatif kalitesinin iyileştirilmesi, travmayı en aza indirmek için gelişmiştir. Bu kavram aynı zamanda mide kanseri için laparoskopik cerrahi uygulanan beri, bazı deneyimli laparoskopik cerrahlar minilaparotomi önlemek için çalıştık. gastri için total laparoskopik gastrektomi (TLG)c kanseri tüm işlemler numune rezeksiyonu ve anastomoz için ek minilaparotomi gerektirmeden, sadece laparoskopik cihazlar kullanılarak tamamlandı gerektirir. Laparotomi gerektiren bu açmak için daha az ağrı ve daha hızlı iyileşme nispetle cerrahi sonuçlarının tipi veya laparoskopi yardımlı cerrahi yana, daha fazla cerrah tercih. 5,6 Ancak, mide kanseri için TLG bir engel doğrudan görselleştirme veya palpasyon olmadan tümör lokalizasyonu olan mide rezeksiyonu alanı belirlemek için. rezeksiyon marjı tümör olmaması mide kanseri cerrahisinde başarı elde etmek çok önemlidir. Mide kanseri için uzak gastrektomi sırasında rezeksiyon marjı tümör tutulumu varsa, ek rezeksiyon kalan midede tümör bırakarak önlemek için gereklidir. açık ve laparoskopi yardımlı cerrahide, primer tümör kolayca geçici gastrostomi yoluyla palpasyon veya doğrudan görselleştirme ile lokalize edilebilir. Ancak, prima, çünküry tümör kolayca zor olabilir TLG içinde EGC için rezeksiyon marjlarını belirleyen, laparoskopik görünümde algılanmaz. Rezeksiyon kenar belirlemek için ek öncesi gastroskopi gerektiren birçok başka yöntem önerilmiştir. 7-9 Bununla birlikte, ek bir ameliyat öncesi gastroskopi hastalar için rahatsız edici olabilir. intraoperatif gastroskopi doğrudan mide orta üçte mide kanseri için TLG sırasında tümörlerin işaretlemek için bir prosedür tanıttı. Bu protokol, biz endoskopik submukozal diseksiyon için mutlak endikasyon dahil değildir preoperatif çalışmalar erken mide kanserlerinin, hastalar için laparoskopik cerrahi uygulandı.

<table><tbody><tr><td>Pentothal Sodium</td><td>JW pharmatheutical Co.</td><td>644912100</td><td>It was used as induction asgent</td></tr><tr><td>Rocumeron</td><td>&amp;nbsp;Ilsung pharmatheutical Co.</td><td>655402960</td><td>It was used for general anesthestia as muscle relaxant.</td></tr><tr><td>SevoFRAN</td><td>Hana pharmatheutical Co.</td><td>657801060</td><td>It was used as general anesthetics</td></tr><tr><td>Endoscopy system</td><td>Olympus Corp.</td><td>CLV-260</td><td>It was used for intraoperative GFS</td></tr><tr><td>Laparoscopic surgery system</td><td>Striker Endoscopy</td><td>1488 HD 3-CHIP</td><td>It was a system for laparoscopic surgery</td></tr><tr><td>Ultrasonic scissor</td><td>Johnson and Johnson Medical Corp.</td><td>HAR23</td><td>It was used during tissue dissection</td></tr><tr><td>Laparoscopic clip</td><td>Johnson and Johnson Medical Corp.</td><td>ER420</td><td>It was used for ligation of the vessels.</td></tr><tr><td>Indigo carmine</td><td>Korea United Pharma</td><td>Carmine</td><td>It was injected into the gastric wall</td></tr><tr><td>Linear stapler</td><td>Johnson and Johnson Medical Corp.</td><td>ECHELON FLEX Powered Endopath Stapler</td><td>It was used for resection the stomach</td></tr><tr><td>Gastroscopic injector</td><td>TaeWoong Medical</td><td>Cobra injector</td><td>I was used for gastroscopic injection of blue dye</td></tr></tbody></table>

intraoperative gastroscopy for tumor localization in laparoscopic surgery for gastric adenocarcinoma

midesinin serozal yüzeyine maruz kalmaması mide kanseri için belirleyici rezeksiyon marjları, tamamen laparoskopik gastrektomi (TLG) sırasında en önemli işlemdir. Bu protokolün amacı, doğrudan mide orta üçte mide kanseri için TLG sırasında tümörlerin işaretlemek için, intraoperatif gastroskopi için bir prosedür tanıtmaktır. Midenin orta üçte adenokarsinom tanısı almış hastalar bu olgu serisinde alındı. Ameliyattan önce, tümör lokalizasyonu için ek gastroskopi yapılmaz. Genel anestezi altında, midenin laparoskopik mobilizasyon ilk gerçekleştirilir. duodenum birinci kısmı pankreas mobilize ve gastroskopik işlem için, diğer tarafa cerrah hamle kenetlenmiş sonra. mideye ağız boşluğundan bir gastroskopi yerleştirilmesi üzerine, 2 - indigo karmin 3 cc mide mu içine endoskopik enjektör aracılığıyla uygulanırmide yakın kenarda Sistemik lupus katmanı. Laparoskopik görünümde lekeli seroza yeri tümör özofagogastrik kavşağına çok yakın olması durumunda distal subtotal gastrektomi, ancak total gastrektomi yapılır rehberlik etmek için kullanılır. Bir örnek yeniden önce tümör rezeksiyon marjı yeterli uzunlukta onaylamak için uzak gastrektomi sonrası örneklenir. Olgu serimizde, tüm hastalar tümör içermeyen marjları vardı ve hiçbir ek rezeksiyonu gerekli. gastroskopik prosedürü ile ilgili herhangi bir morbidite ve kademeli olarak yaklaşık beş dakika düşmüştür sahip prosedür için gerekli zaman vardı. Tümör lokalizasyonu için İntraoperatif gastroskopi tamamen laparoskopik distal gastrektomi geçiren mide kanseri hastaları için doğru ve tolere yöntemdir.

intraoperatif gastroskopi yapılan 20 hastanın, 18 gastroskopi de bulguların rehberliğinde distal subtotal gastrektomi, uygulandı. Proksimal tümör marjı özofagogastrik kavşağına çok yakın olduğu için intraoperatif gastroskopi belirlenir Ancak, biz, iki hastada total gastrektomi uygulandı. Proksimal rezeksiyon marjı tümör arasındaki mesafe 3.5 cm, bu iki hastada 2.5 cm, sırası ile (Tablo 1). <p class="jove_content" fo:keep-together.within-page="1...

Watch this Scientific Journal Video about Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma at JoVE.com

Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma

In early gastric cancer, the aim of surgery is to precisely remove the distal stomach including the primary tumor. To do this, accurate localization of the tumor is crucial, especially in totally laparoscopic surgery. This protocol describes a procedure for intraoperative gastroscopy in totally laparoscopic subtotal gastrectomy.

Mide Adenokarsinomu için Laparoskopik Cerrahi Tümör lokalizasyonu İntraoperatif Gastroskopi

Determining resection margins for gastric cancer, which are not exposed to the serosal surface of the stomach, is the most important procedure during ...

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12.6K Görüntüleme.  Ajou University, School of Medicine. In early gastric cancer, the aim of surgery is to precisely remove the distal stomach including the primary tumor. To do this, accurate localization of the tumor is crucial, especially in totally laparoscopic surgery. This protocol describes a procedure for intraoperative gastroscopy in totally laparoscopic subtotal gastrectomy.

Video: Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma

Multispectral Real-time Fluorescence Imaging for Intraoperative Detection of the Sentinel Lymph Node in Gynecologic Oncology

The prognosis in virtually all solid tumors depends on the presence or absence of lymph node metastases.1-3 Surgical treatment most often combines radical excision of the tumor with a full lymphadenectomy in the drainage area of the tumor. However, removal of lymph nodes is associated with increased morbidity due to infection, wound breakdown and lymphedema.4,5 As an alternative, the sentinel lymph node procedure (SLN) was developed several decades ago to detect the first draining lymph node from the tumor.6 In case of lymphogenic dissemination, the SLN is the first lymph node that is affected (Figure 1). Hence, if the SLN does not contain metastases, downstream lymph nodes will also be free from tumor metastases and need not to be removed. The SLN procedure is part of the treatment for many tumor types, like breast cancer and melanoma, but also for cancer of the vulva and cervix.7 The current standard methodology for SLN-detection is by peritumoral injection of radiocolloid one day prior to surgery, and a colored dye intraoperatively. Disadvantages of the procedure in cervical and vulvar cancer are multiple injections in the genital area, leading to increased psychological distress for the patient, and the use of radioactive colloid.
Multispectral fluorescence imaging is an emerging imaging modality that can be applied intraoperatively without the need for injection of radiocolloid. For intraoperative fluorescence imaging, two components are needed: a fluorescent agent and a quantitative optical system for intraoperative imaging. As a fluorophore we have used indocyanine green (ICG). ICG has been used for many decades to assess cardiac function, cerebral perfusion and liver perfusion.8 It is an inert drug with a safe pharmaco-biological profile. When excited at around 750 nm, it emits light in the near-infrared spectrum around 800 nm. A custom-made multispectral fluorescence imaging camera system was used.9.
The aim of this video article is to demonstrate the detection of the SLN using intraoperative fluorescence imaging in patients with cervical and vulvar cancer. Fluorescence imaging is used in conjunction with the standard procedure, consisting of radiocolloid and a blue dye. In the future, intraoperative fluorescence imaging might replace the current method and is also easily transferable to other indications like breast cancer and melanoma.

Fluorescence imaging is a promising innovative modality for image-guided surgery in surgical oncology. In this video we describe the technical procedure for detection of the sentinel lymph node using fluorescence imaging as showcased in gynecologic oncologicy. A multispectral fluorescence camera system, together with the fluorescent agent indocyanine green, is applied.

Jinekolojik Onkoloji Sentinel lenf nodu intraoperatif Algılama için Multispektral Gerçek zamanlı Floresans Görüntüleme

The prognosis in virtually all solid tumors depends on the presence or absence of lymph node metastases.1-3 Surgical treatment most often combines radical ...

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Low-Cost Single-Port (LoCoSP) Device for a Transcervical Approach in Minimally Invasive Transhiatal Esophagectomy

Esophagectomy remains the preferred option to achieve curative treatment in advanced esophageal cancer, but the choice of surgical approach remains controversial. A transthoracic approach may improve lymph node dissection, but it has considerable morbidity and respiratory complications. Transhiatal access has been demonstrated as an efficient means of minimizing post-operative complications. Minimally invasive transhiatal esophagectomy may reduce operative trauma and morbidity as well as enhance postoperative recovery with no compromise in cancer recurrence or survival. Nevertheless, it has a technical limitation in terms of cervical esophagus dissection. Thus, a low-cost single-port device was developed to complete upper mediastinal dissection by a transcervical approach during minimally invasive transhiatal esophagectomy. This device uses a nasogastric tube, a number-eight sterile glove, a sterile sponge, and 3 permanent 5-mm trocars. The step-by-step process of transhiatal esophagectomy and the development of this device are described. This technique allows for the dissection of the upper mediastinum, as well as the esophagus over the aortic arch and behind the superior portion of the trachea. The harvesting of lymph nodes along the left recurrent laryngeal nerve and paratracheals was improved.

Low-Cost Single-Port LoCoSP Device for a Transcervical Approach in Minimally Invasive Transhiatal Esophagectomy

Here, we describe a step-by-step description of transhiatal esophagectomy and the development of a low-cost single-port device for a transcervical approach in a minimally invasive transhiatal esophagectomy.

Minimal İnvaziv Transhiatal Özofagtomide Transerviziv Yaklaşım için Düşük Maliyetli Tek Bağlantı Noktalı (LoCoSP) Cihaz

Esophagectomy remains the preferred option to achieve curative treatment in advanced esophageal cancer, but the choice of surgical approach remains ...

Laparoscopy-endoscopy Cooperative Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumors

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this approach makes an innovative improvement in the treatment of G-GISTs that are less than 5 cm in size. Laparoscopy-endoscopy cooperative surgery (LECS) is used to combine endoscopic and laparoscopic surgeries, fully realizing their respective advantages and avoiding their drawbacks. The main steps are as follows. First, gastroscopy and laparoscopy are combined to confirm the location and boundary of the tumor. Tumor resection is carried out laparoscopically, guided by a gastroscope. The specimen is removed orally and the gastric wound closed laparoscopically. Then, gastroscopy and laparoscopy are combined to determine whether there is wound bleeding, if the suture is satisfactory, and if the gastric cavity is deformed.
LECS has natural advantages in the treatment of G-GISTs that are less than 5 cm in size. The accurate estimation of tumor location and boundary greatly improves the complete resection rate of tumors. The risk of tumor rupture is substantially reduced, and the long-term prognosis of patients is significantly improved. The process allows for accurate resection of the tumor, maximum preservation of normal gastric tissue and organ function, and avoids postoperative gastric deformation. The patient's postoperative rehabilitation is greatly accelerated, and oral feeding can resume on the day of the operation. The specimen is taken out through the mouth to avoid the need for an extended abdominal incision. This greatly reduces the patient's postoperative pain and scarring. The method greatly shortens the postoperative hospital stay (i.e., discharge is possible on the day after the operation), increasing the turnover of hospital beds.

Laparoscopy-endoscopy cooperative surgery is appropriate for the treatment of gastric gastrointestinal stromal tumors less than 5 cm in size. It can achieve the respective advantages of endoscopic and laparoscopic surgeries while avoiding their drawbacks.

Gastrik Gastrointestinal Stromal Tümörlerin Tedavisinde Laparoskopi-Endoskopi Kooperatifi Cerrahisi

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this ...

Fluorescent Laparoscopic Central Hepatectomy for Liver Cancer Using Indocyanine Green Negative Staining

Laparoscopic hepatectomy is an important treatment method for liver cancer. In the past, the resection boundary was usually determined by intraoperative ultrasound, important vascular structures, and surgeon experience. With the development of anatomical hepatectomy, visual surgery technology has gradually been applied to this type of surgery, particularly indocyanine green (ICG)-guided anatomical hepatectomy. As ICG can be specifically ingested by hepatocytes and used for fluorescence tracing, negative staining techniques have been applied according to different tumor positions. Under ICG fluorescent guidance, the surface boundary and deep resection plane can be more accurately displayed during liver resection. Thus, the tumor-bearing liver segment can be anatomically removed, which helps to avoid damage to important vessels and reduce ischemia or congestion of the remaining liver tissue. Finally, the incidence of postoperative biliary fistula and liver dysfunction is reduced; therefore, a better prognosis is obtained after the resection of liver cancer. Centrally located liver cancer is usually defined as a tumor located at segments 4, 5, or 8 that requires resection of the middle section of the liver. These are among the most difficult hepatectomies to perform because of the large surgical wounds and multiple vessel transections. Based on the specific tumor location, we formulated the required resection ranges by designing personalized fluorescent staining strategies. By completing anatomical resection based on the portal territory, this work aims to achieve the best therapeutic effect.

The present protocol describes fluorescent negative staining in laparoscopic central hepatectomy. This technique can make hepatectomy more accurate and precise.

İndosiyanin Yeşili Negatif Boyama Kullanılarak Karaciğer Kanseri için Floresan Laparoskopik Santral Hepatektomi

Laparoscopic hepatectomy is an important treatment method for liver cancer. In the past, the resection boundary was usually determined by intraoperative ...

Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction

Reduced-port laparoscopic surgery (RPLS) has been widely used for the radical resection of gastrointestinal tumors. Single-surgeon, three-port, laparoscopic radical resection for sigmoid colon or high rectal cancer with natural orifice specimen extraction surgery (NOSES) has the advantage of a small incision, quick postoperative recovery, and short hospital stay. Yet, there are still only a few reports on NOSES. This paper describes the indications, preoperative preparations, surgical steps, and precautions for single-surgeon, three-port, laparoscopic radical resection of the sigmoid colon and high rectal cancer, and intraoperative specimen collection through the natural orifice. 
The protocol focuses on the steps of radical dissection and the main technical points of resection and reconstruction. At the same time, a procedure for fixing an anvil seat by self-traction of extracorporeal silk thread, used for purse-string suture fixation after the proximal anvil was placed in the abdominal cavity, was creatively improved. This operation could effectively avoid problems such as an insufficient proximal intestinal tube, shaking off the anvil seat, and weak purse-string suture during a single operation. The surgical care had less variability and was easy to perform, effectively avoiding postoperative anastomotic leakage and bleeding due to excessive intraoperative anastomotic tissue. This surgery could be widely promoted in primary hospitals.

Here, we present a protocol to successfully perform single-surgeon, three-port, laparoscopic resection for colorectal cancer with natural orifice specimen extraction.

Doğal Orifis Örneği Ekstraksiyonu ile Kolorektal Kanser için Tek Cerrahlı, Üç Portlu, Laparoskopik Rezeksiyonun Klinik Uygulaması

Reduced-port laparoscopic surgery (RPLS) has been widely used for the radical resection of gastrointestinal tumors. Single-surgeon, three-port, ...

Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver

Laparoscopic anatomic hepatectomy (LAH) has become increasingly prevalent worldwide in recent years. However, LAH remains a challenging procedure due to the anatomical characteristics of the liver, with intraoperative hemorrhage being a primary concern. Intraoperative blood loss is the leading cause of conversion to open surgery; therefore, effective management of bleeding and hemostasis is crucial for a successful LAH.
The two-surgeon technique is proposed as an alternative to the traditional single-surgeon approach, with potential benefits in reducing intraoperative bleeding during laparoscopic hepatectomy. However, there remains a lack of evidence to determine which mode of the two-surgeon technique yields superior patient outcomes. Besides, to our knowledge, the LAH technique, which involves the use of a cavitron ultrasonic surgical aspirator (CUSA) by the primary surgeon while an ultrasonic dissector by the second surgeon, has been rarely reported before.
Herein, we present a modified, two-surgeon LAH technique, wherein one surgeon employs a CUSA while the other uses an ultrasonic dissector. This technique is combined with a simple extracorporeal Pringle maneuver and low central venous pressure (CVP) approach. In this modified technique, the primary and secondary surgeons utilize a laparoscopic CUSA and an ultrasonic dissectorconcurrently to achieve precise and expeditious hepatectomy. A simple extracorporeal Pringle maneuver, combined with the maintenance of low CVP, is employed to regulate the hepatic inflow and outflow in order to minimize intraoperative bleeding. This approach facilitates the attainment of a dry and clean operative field, which allows for the precise ligation and dissection of blood vessels and bile ducts. The modified LAH procedure is simpler and safer due to its effective control over bleeding as well as the seamless transition between the roles of primary and secondary surgeons. It holds great promise for future clinical applications.

Here, we present a protocol to perform a modified laparoscopic anatomic hepatectomy using improved techniques and instruments.

Modifiye Laparoskopik Anatomik Hepatektomi: Basit Ekstrakorporeal Pringle Manevrası ile Kombine İki Cerrahlı Teknik

Laparoscopic anatomic hepatectomy (LAH) has become increasingly prevalent worldwide in recent years. However, LAH remains a challenging procedure due to ...

Advancing LRPS: Optimal Techniques for Challenging Liver Resections

Techniques of Laparoscopic Right Posterior Sectionectomy: Glissonian Approach and a Parenchymal Transection Technique

Laparoscopic liver resections (LLR) have been widely accepted as a treatment option for liver tumors. They offer several advantages over open liver resections, including less blood loss, reduced wound pain, and shorter hospital stays with a comparable oncological outcome. However, laparoscopic resection of lesions in the right posterior section of the liver is challenging due to difficulties in bleeding control and visualizing the surgical field. In the past, laparoscopic right posterior sectionectomy (LRPS) was still in the exploration phase, with undefined risks in the Second International Consensus Conference on LLR in 2014. However, recent technological advancements and increased surgical experience have shown that LRPS can be safe and feasible. It has been found to reduce hospital stay and blood loss compared to open surgery. This manuscript aims to provide a detailed description of the steps involved in LRPS. The key factors contributing to our success in this challenging procedure include proper liver retraction and exposure, the use of an intrahepatic Glissonian approach for inflow control, a technique called the 'ultrasonic scalpel mimic Cavitron ultrasonic surgical aspirator (CUSA)' for parenchymal transection, early identification of the right hepatic vein, and meticulous bleeding control using bipolar diathermy.

Here, we present a protocol to perform laparoscopic right posterior sectionectomy, focusing on two key aspects: the intrahepatic Glissonian approach for inflow control and a parenchymal transection technique using an ultrasonic surgical aspirator.

Laparoskopik Sağ Posterior Seksiyonektomi Teknikleri: Glissonyen Yaklaşım ve Parankimal Transeksiyon Tekniği

Laparoscopic liver resections (LLR) have been widely accepted as a treatment option for liver tumors. They offer several advantages over open liver ...

Transumbilical Endoscopic Resection of Intra-abdominal Mesenchymal Tumor

Gastrointestinal stromal tumors (GISTs) typically occur in the stomach and proximal small intestine but can also be found in any other part of the digestive tract, including the abdominal cavity, albeit rarely. In the present case, the tumor was resected endoscopically through the anterior gastric wall. Computed tomography (CT) scan and gastroscopy of a 60-year-old woman revealed submucosal lesions in the gastric body. The possibility of a stromal tumor was considered more likely. The endoscopic surgery was performed under endotracheal anesthesia. After a solution had been injected at the lesion site in the stomach, the entire gastric wall was dissected to expose the tumor. As the lesion was in the abdominal cavity and its base was attached to the abdominal wall, it was accessed using a sterilized PCF colonoscope. A sodium chloride injection was administered at the base. The tumor was then peeled along its boundaries using the hooking and excision knife combined with the precutting knife. Subsequently, the tumor was pulled into the stomach through the incision made in the stomach and then extracted externally through the upper digestive tract using the ERCP spiral mesh basket. After confirming the absence of bleeding at the incision site, the endoscope was returned to the stomach, and the stomach opening was closed using purse-string sutures. The patient recovered satisfactorily following the surgery and was discharged on day 4. Histological examination revealed a low-risk stromal tumor (spindle cell type, &lt;5 mitosis/50 high-power fields [HPF]). Immunohistochemistry revealed positive staining for CD34 and CD117, negative staining for SMA, positive staining for DOG1, and negative staining for S100. Additionally, the expression of ki67 was 3%.

The article introduces the surgical method, endoscopic submucosal dissection (ESD) for the complete removal of intra-abdominal tumors using natural orifice transluminal endoscopic surgery (NOTES). The procedure reaches the stomach by using gastrointestinal endoscopy, creating a controlled perforation for tumor removal, followed by stitching the gastric incision.

Gastrointestinal stromal tumors (GISTs) typically occur in the stomach and proximal small intestine but can also be found in any other part of the ...

Single Incision Plus One Port Laparoscopic Proximal Gastrectomy with Double Channel Anastomosis for Gastric Cancer Treatment

Single-incision plus one-port laparoscopic proximal gastrectomy with double-channel anastomosis (SILT-DT) is a minimally invasive surgical approach for treating proximal gastric cancer. This technique includes comprehensive laparoscopic resection of the proximal stomach, lymph node dissection, and double-tract anastomosis. By integrating single-port laparoscopic surgery with an auxiliary operating hole, SILT-DT reduces procedural difficulty while facilitating the placement of an abdominal drainage tube. Compared to the traditional five-port laparoscopic gastrectomy, SILT-DT requires fewer ports and results in shorter incision lengths, contributing to reduced postoperative pain and faster recovery. A thorough preoperative evaluation was conducted to ensure procedural success, with factors such as tumor size, stage, location, and patient BMI carefully considered. This comprehensive assessment allowed for optimal patient selection and surgical planning. Postoperative follow-up demonstrated no significant complications, underscoring the safety and efficacy of SILT-DT. This innovative technique offers a promising minimally invasive alternative for managing proximal gastric cancer while maintaining excellent clinical outcomes.

The single-incision plus one-port laparoscopic proximal gastrectomy with double-channel anastomosis was initially employed for the radical resection of proximal gastric cancer. This study demonstrated the feasibility of the procedure and laid a foundation for further research.

Mide Kanseri Tedavisi için Tek İnsizyon Artı Bir Port Laparoskopik Proksimal Gastrektomi ile Çift Kanal Anastomozlu

Single-incision plus one-port laparoscopic proximal gastrectomy with double-channel anastomosis (SILT-DT) is a minimally invasive surgical approach for ...

Robotics in Surgery: A Modular Robotic Platform Driven Gastric Wedge Resection

Robotic-assisted surgery has become increasingly popular since the introduction of the first robotic platform. Recently, a modular robotic system was approved for in-human use in Europe. Possible applications for this new robotic system are being explored, and standardized approaches are evolving. In lieu of this, a gastric wedge resection and the standardized setup for upper gastrointestinal procedures using this new system are presented here. This safe and feasible robotic procedure is demonstrated in a 69-year-old patient with a gastric tumor. All steps of the surgery are described in a detailed and reproducible manner. The article also details trocar positioning, arm adjustments, and required surgical instruments. Docking time amounted to 13 min, whereas the console time took 115 min. The patient was discharged after 4 days after ensuring an uneventful course. The presented method is also suitable for other surgical purposes, such as fundoplications or hiatoplasties, and ensures both generalizability and reproducibility.

Robotically assisted surgery has become highly popular in recent years. Presented here is the standard care for upper gastrointestinal procedures, including a demonstration of a robotic-assisted gastric wedge resection using a modular robotic device.

Cerrahide Robotik: Modüler Robotik Platform Tahrikli Gastrik Kama Rezeksiyonu

Robotic-assisted surgery has become increasingly popular since the introduction of the first robotic platform. Recently, a modular robotic system was ...