Resección laparoendoscópica de tumor de la unión gastroesofágica / Laparoendoscopic resection of a tumor of the gastroesophageal junction

RESUMEN La resección gástrica atípica ha demostrado ser beneficiosa para tumores submucosos. La técnica pre senta mayor riesgo cuando estos se desarrollan próximos a la unión esófago-gástrica (UEG). Para esta limitación se propuso la resección intragástrica mediante una técnica mixta combinando laparoscopia y endoscopia. En nuestro medio no existen publicaciones al respecto. Se trata de una mujer de 42 años, con lesión subepitelial-subcardial de 2 cm, evaluada mediante videoendoscopia alta (VEDA), compa tible con tumor del estroma gastrointestinal (GIST) evaluado mediante ecoendoscopia. La lesión fue resecada mediante abordaje combinado laparoendoscópico. Bajo visión laparoscópica se introdujeron en cavidad abdominal trocares con balón, y bajo visión endoscópica intragástrica se introdujeron estos en el estómago y se fijó la pared gástrica a la pared abdominal insuflando dichos balones. Posterior mente se realizó la resección de la lesión con sutura mecánica. El abordaje combinado es seguro y eficaz, simple en manos entrenadas, pero constituye una opción reproducible en casos seleccionados.

ABSTRACT Atypical gastric resection has proved to be beneficial to treat submucosal tumors. The technique is more difficult when these tumors develop next to the gastroesophageal junction (GEJ). Intragastric resection combining endoscopic and laparoscopic approach was proposed to solve this limitation. There are no publications about this technique in our environment. A 42-year-old female patients with a 2-mm subepithelial tumor below the cardia evaluated by upper gastrointestinal (UGI) videoendoscopy and endoscopic ultrasound suggestive of a gastrointestinal stroma tumor (GIST) underwent resection using the combined laparo-endoscopic approach. Under laparoscopic guidance, balloon-tipped trocars were introduced in the abdominal cavity and then into the stomach using endoscopic view. The balloons were inflated to fix the gastirc wall to the abdominal wall. The lesion was resected using mechanical stapler. The combined approach is safe and efficient, and simple to perform for trained professionals, constituting a reproducible option in selected cases.

Transperitoneal laparoendoscopic single-site nephrectomy combined with flexible 3-D laparoscope for partial nephrectomy in pigs: A preliminary experience / 第二军医大学学报

Objective: To use transperitoneal laparoendoscopic single-site (LESS) partial nephrectomy combined with flexible 3-D laparoscope for partial nephrectomy in pigs, and to introduce our experience on LESS training in a pig model for partial nephrectomy. Methods: A male pig was given general anesthesia and was put in a supine position. A 3.5 cm incision was made through the right abdominal rectus. A multi-channel QuadPort(Olympus™) was established. Artificial pneumoperitoneum was created by 14 mmHg(1 mmHg=0.133 kPa); the lower pole and the kidney pedicle of the right kidney were isolated. The lower pole of the right kidney was resected after the renal artery was blocked. Figure-8 sutures were used to close the wound, with no notable bleeding noticed after opening the blood. The specimen was enclosed in an endoscopic pouch and pulled out from the incision. Results: The procedure was smoothly completed without any extra incision. The operating time was 47 min; the period of renal artery occlusion was 21 min (5 min for resection, 16 min for stitching); and the intraoperative blood loss was 20 mL. There was no complication during the operation. Conclusion: Our initial experience shows that 3D-LESS partial nephrectomy procedure is technically difficult, but it is safe, feasible and effective. Flexible 3D laparoscopy can provide clear 3D visualization, improving the operating accuracy and reducing the fighting of instruments. The pig model used in this study can help surgeons to obtain experience on 3D-LESS partial nephrectomy.

Transperitoneal 3D laparoendoscopic single-site (LESS) nephrectomy: The first clinical case in China / 第二军医大学学报

Objective To summarize our experience on the first clinical case of transperitoneal 3D laparoendoscopic single- site(LESS) nephrectomy in mainland China, and to assess its safety and feasibility after obtaining the informed consents. Methods On August 5, 2013, we performed a 3D LESS nephrectomy using Karl Storz 3D endoscope and a multi-channel Quad- Port (Olympus™) through a 3 cm skin incision at our institute. The patient was a 69 years old man, with a body mass index (BMI) of 27. 7 kg/m2 and a preoperative serum creatinine level of 81 μmol/L. 99mTc DTPA was used to determine the glomerular filtration rate(GFR). The preoperative unilateral renal functionwas 65 mL/min for the left side and 9. 5 mL/min for the right side. And therefore he was diagnosed as "right kidney severe hydrocephalus" and received right nephrectomy. A 3 cm external retus incision was made at the umbilicus level at 1 cm site. After dissection of the renal pedicle blood vessels the renal blood vessels, the ureterogonadal packet was left en bloc and transected at the level when crossing the common iliac vessels. The kidney was extracted through the original incision after the skin incision was extended to 4 cm. Results The procedure was smoothly completed without any extra skin incision. The operating time was 154 min, with an estimated blood loss of 150 mL. The gastrointestinal function recovered on the first day after operation. Postoperative serum creatinine level on the first day was 76 μmol/L. Donor Visual Analog Pain Scores at postoperative day 1, 2 and 3 were 2/10, 1/10 and 0/10, respectively. The recovery of the patient was uneventful and he was discharged on the 3rd postoperative day. Conclusion Transperitoneal 3D laparoendoscopic single-site nephrectomy is safe, feasible and effective. It has the clinical benefits of less pain, rapid recovery and small incision. The procedure allows for a strong stereo perception, accurate manipulation, and a decreased demand for hand-eye coordination of hand, with a promising clinical future. But more clinical experience needs to be accumulated through more cases.