Name: intraoperative gastroscopy for tumor localization in laparoscopic surgery for gastric adenocarcinoma
Uploaded: 2016-08-09T13:00:00
Description: Watch this Scientific Journal Video about Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma at JoVE.com

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 Statement: Denne procedure med menneskelige forsøgspersoner er blevet godkendt af Institutional Review Board (IRB) ved Ajou Universitetshospital. 1. Forberedelse til Kirurgi <ol><li> Tillad en blød kost en dag før operationen, med intet gennem munden efter midnat før operationen. Bemærk: Du må ikke indsætte en nasogastrisk sonde før og under operationen. Denne protokol bruger ikke nogen røret for at punktere maven. I stedet for dette kan den intra-gastrisk gas suges ve...

<ol>
	<li>Kim, Y. W., Yoon, H. M., Eom, B. W., Park, J. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=History+of+minimally+invasive+surgery+for+gastric+cancer+in+Korea.">History of minimally invasive surgery for gastric cancer in Korea.</a> J Gastric Cancer. 12, 13-17 (2012).</li><li>Kim, H. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Morbidity+and+mortality+of+laparoscopic+gastrectomy+versus+open+gastrectomy+for+gastric+cancer:+an+interim+report--a+phase+III+multicenter,+prospective,+randomized+Trial+(KLASS+Trial).">Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report--a phase III multicenter, prospective, randomized Trial (KLASS Trial).</a> Ann Surg. 251, 417-420 (2010).</li><li>Kim, M. C., Kim, K. H., Kim, H. H., Jung, G. 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Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Is+totally+laparoscopic+gastrectomy+less+invasive+than+laparoscopy-assisted+gastrectomy?:+prospective,+multicenter+study.">Is totally laparoscopic gastrectomy less invasive than laparoscopy-assisted gastrectomy?: prospective, multicenter study.</a> J Gastrointest Surg. 12, 1015-1021 (2008).</li><li>Hyung, W. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+tumor+localization+using+laparoscopic+ultrasonography+in+laparoscopic-assisted+gastrectomy.">Intraoperative tumor localization using laparoscopic ultrasonography in laparoscopic-assisted gastrectomy.</a> Surg Endosc. 19, 1353-1357 (2005).</li><li>Jeong, O., Cho, S. B., Joo, Y. E., Ryu, S. Y., Park, Y. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Novel+technique+for+intraoperative+tumor+localization+during+totally+laparoscopic+distal+gastrectomy:+endoscopic+autologous+blood+tattooing.">Novel technique for intraoperative tumor localization during totally laparoscopic distal gastrectomy: endoscopic autologous blood tattooing.</a> Surg Endosc. 26, 1778-1783 (2012).</li><li>Kim, H. I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+portable+abdominal+radiograph+for+tumor+localization:+a+simple+and+accurate+method+for+laparoscopic+gastrectomy.">Intraoperative portable abdominal radiograph for tumor localization: a simple and accurate method for laparoscopic gastrectomy.</a> Surg Endosc. 25, 958-963 (2011).</li><li>Kim, H. I., Cho, I., Jang, D. S., Hyung, W. 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I denne protokol, vi indført en procedure for intraoperativ gastroskopi til præcist og pålideligt identificere tumor placering midt tredjedel af maven. Vi var i stand til at udføre distale subtotal gastrektomi baseret på resultaterne af intraoperativ gastroskopi. Til dato er forskellige fremgangsmåder blevet anvendt til at identificere placeringen af ​​tidlig gastrisk cancer hos den laparoskopiske visning. Mest almindelige metoder præoperativ gastroskopisk klipning, og kirurger ku...

Laparoskopisk kirurgi er blevet behandling af valg for tidlig mavekræft i østasiatiske lande, herunder Korea og Japan. 1. Fordelen ved denne operation er blevet godt demonstreret i flere kliniske forsøg for tidlig mavekræft (EGC). 2-4 De fleste af procedurerne i disse forsøg udføres ved laparoskopi, men identifikation af tumor placering blev resektion af maven, herunder den primære tumor, og genopbygning foretages via minilaparotomy. Derfor kirurgi der kræver minilaparotomy er mærket &quot;laparoskopi-assisteret gastrektomi.&quot; For nylig har imidlertid kirurgiske procedurer udviklet sig til at minimere traume, forbedre den postoperative livskvalitet for patienterne. Da dette begreb også er blevet anvendt i laparoskopisk kirurgi for mavekræft, har nogle erfarne laparoskopiske kirurger forsøgt at undgå minilaparotomy. Helt laparoskopisk gastrektomi (TLG) for gastric kræft kræver, at alle procedurer er afsluttet ved hjælp af kun laparoskopisk enheder, uden at det kræver en ekstra minilaparotomy for prøven resektion og anastomose. Da denne type kirurgi resulterer i mindre smerte og hurtigere genopretning i forhold til at åbne eller laparoskopi-assisteret kirurgi, som kræver laparotomi, flere kirurger foretrækker det. 5,6 Men en hindring for TLG for mavekræft er tumor lokalisering uden direkte visualisering eller palpation at bestemme arealet af maven resektion. Tumor fravær på resektionsranden er meget vigtigt at opnå succes i gastrisk cancer kirurgi. Hvis der er tumor involvering på resektionsranden under distal gastrektomi for mavekræft, er der behov for yderligere resektion for at undgå, at tumor i den resterende maven. I åben og laparoskopi-assisteret kirurgi, kan den primære tumor let lokaliseres ved palpation eller direkte visualisering gennem et midlertidigt gastrostomi. Men fordi primary tumor ikke let påvises i den laparoskopiske opfattelse, bestemmelse resektionsrandene for EGC i TLG kan være vanskeligt. Der er blevet foreslået adskillige andre metoder kræver yderligere præoperativ gastroskopi for at bestemme resektionsmarginer. 7-9 kan imidlertid yderligere præoperativ gastroskopi være ubelejligt for patienterne. Vi indførte en procedure for intraoperativ gastroskopi til direkte markere tumorer under TLG for mavekræft i den midterste tredjedel af maven. I denne protokol, vi anvendte den laparoskopisk kirurgi for patienter med tidlige gastrisk kræft ved de præoperative undersøgelser, som ikke er medtaget i absolut indikation for endoskopisk submucosa dissektion.

<table border="0" cellpadding="0" cellspacing="0" width="717">
	<tbody>
		<tr height="20">
			<td height="20" style="height:20px;width:216px;">Pentothal Sodium</td>
			<td style="width:157px;">JW pharmatheutical Co.</td>
			<td style="width:119px;">644912100</td>
			<td style="width:225px;">It was used as induction asgent</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:216px;">Rocumeron</td>
			<td style="width:157px;">&#160;Ilsung pharmatheutical Co.</td>
			<td style="width:119px;">655402960</td>
			<td style="width:225px;">It was used for general anesthestia as muscle relaxant.</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:216px;">SevoFRAN</td>
			<td style="width:157px;">Hana pharmatheutical Co.</td>
			<td style="width:119px;">657801060</td>
			<td style="width:225px;">It was used as general anesthetics</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:216px;">Endoscopy system</td>
			<td style="width:157px;">Olympus Corp.</td>
			<td style="width:119px;">CLV-260</td>
			<td style="width:225px;">It was used for intraoperative GFS</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:216px;">Laparoscopic surgery system</td>
			<td style="width:157px;">Striker Endoscopy</td>
			<td style="width:119px;">1488 HD 3-CHIP</td>
			<td style="width:225px;">It was a system for laparoscopic surgery</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:216px;">Ultrasonic scissor</td>
			<td style="width:157px;">Johnson and Johnson Medical Corp.</td>
			<td style="width:119px;">HAR23</td>
			<td style="width:225px;">It was used during tissue dissection</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:216px;">Laparoscopic clip</td>
			<td style="width:157px;">Johnson and Johnson Medical Corp.</td>
			<td style="width:119px;">ER420</td>
			<td style="width:225px;">It was used for ligation of the vessels.</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:216px;">Indigo carmine</td>
			<td style="width:157px;">Korea United Pharma</td>
			<td style="width:119px;">Carmine</td>
			<td style="width:225px;">It was injected into the gastric wall</td>
		</tr>
		<tr height="60">
			<td height="60" style="height:60px;width:216px;">Linear stapler</td>
			<td style="width:157px;">Johnson and Johnson Medical Corp.</td>
			<td style="width:119px;">ECHELON FLEX Powered Endopath Stapler</td>
			<td style="width:225px;">It was used for resection the stomach</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:216px;">Gastroscopic injector</td>
			<td style="width:157px;">TaeWoong Medical</td>
			<td style="width:119px;">Cobra injector</td>
			<td style="width:225px;">I was used for gastroscopic injection of blue dye</td>
		</tr>
	</tbody>
</table>

intraoperative gastroscopy for tumor localization in laparoscopic surgery for gastric adenocarcinoma

Bestemmende resektionsrandene for gastrisk cancer, som ikke er udsat for serøse overflade af maven, er den vigtigste procedure under totalt laparoskopisk gastrektomi (TLG). Formålet med denne protokol er at indføre en procedure for intraoperativ gastroskopi for at direkte markere tumorer under TLG for mavekræft i den midterste tredjedel af maven. Patienter, der blev diagnosticeret med adenocarcinom i den midterste tredjedel af maven blev indrulleret i dette tilfælde serie. Før operationen, er yderligere gastroskopi for tumorlokalisering ikke udført. Under generel anæstesi, er laparoskopisk mobilisering af maven udføres først. Efter den første del af duodenum mobiliseres fra bugspytkirtlen og fastspændt, kirurgen bevæger sig til den anden side for gastroskopisk procedure. Om indsættelse af en gastroskop gennem mundhulen i maven, 2 - er 3 cc af indigotin administreres via en endoskopisk injektor ind i gastrisk muscle lag ved den proximale kant af maven. Placeringen af ​​farvede serosa i den laparoskopiske henblik anvendes til at lede distale subtotal gastrektomi imidlertid total gastrektomi udføres, hvis tumoren er for tæt på esophagogastric junction. En model er samplet efter distal gastrektomi at bekræfte tilstrækkelig længde fra resektion margin til tumor før genopbygning. I vores tilfælde serie havde alle patienter tumor-fri margener og krævede ingen yderligere resektion. Der var ingen dødelighed forbundet med den gastroskopisk procedure, og den tid, der kræves for forsøget foretages gradvist faldet til omkring fem minutter. Intraoperativ gastroskopi for tumor lokalisering er en præcis og tolereret metode til gastrisk kræftpatienter i helt laparoskopisk distal gastrektomi.

Af 20 patienter, som gennemgik intraoperativ gastroskopi, 18 undergik distal subtotal gastrektomi, styret af resultater på gastroskopi. Men vi udførte total gastrektomi på to patienter, fordi den proksimale tumor margin for tæt på esophagogastric krydset, som fastlægges på intraoperativ gastroskopi. Afstanden fra tumoren til den proximale resektionsranden var 3,5 cm og 2,5 cm i disse to patienter (tabel 1). <p class="jove_content" fo:keep-together.within-page=...

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.

Intraoperativ Gastroskopi for Tumor Lokalisering i laparoskopisk kirurgi for gastrisk adenocarcinom

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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