Safety and location analysis of transumbilical endoscopic submucosal dissection with single-basin lymph node dissection in the upper gastric body: a porcine modelopen access
- Authors
- Jeong, Sang-Ho; Min, Jae-Seok; Park, Ji-Ho; Hong, Soon-Chan; Jung, Eun-Jung; Ju, Young-Tae; Jeong, Chi-Young; Lee, Han Shin; Park, Miyeong; Lee, Young-Joon; Ha, Chang Yoon
- Issue Date
- Feb-2020
- Publisher
- SPRINGER
- Keywords
- Endoscopic submucosal dissection; Single-port surgery; Gastric neoplasm; Endoscope; Laparoscopy; Porcine
- Citation
- SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, v.34, no.2, pp.590 - 597
- Indexed
- SCIE
SCOPUS
- Journal Title
- SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES
- Volume
- 34
- Number
- 2
- Start Page
- 590
- End Page
- 597
- URI
- https://scholarworks.bwise.kr/gnu/handle/sw.gnu/6950
- DOI
- 10.1007/s00464-019-06801-2
- ISSN
- 0930-2794
- Abstract
- Background In our previous study, transumbilical endoscopic submucosal dissection (TU-ESD) was revealed to be feasible, but delayed gastric perforation was observed in 30% of ESD sites. In this study, we aimed to verify locations at which it is feasible to perform TU-ESD in the upper gastric body and to demonstrate the safety of TU-ESD in single-basin lymph node dissection (SBLND). Methods In vitro, TU-ESD was performed at three lesion sites (anterior wall, AW; posterior wall, PW; and lesser curvature, LC) in each porcine stomach using an EASIE-R tray (cases = 10). In vivo, TU-ESD was performed with SBLND in 9 pigs. Seven days after the operation, the pigs were sacrificed and examined. Results In the in vitro feasibility study, the TU-ESD time was significantly faster in the PW group (5.9 +/- 2.0 min) than in the LC group (8.5 +/- 1.5 min) (p < 0.05) in all 10 cases. In the in vivo survival study, TU-ESD with SBLND was successfully performed without any complications (N = 9). There were no cases of delayed perforation, and healing ulcers were found in all pigs 7 days after the operation. Ulcer size (5.2 +/- 3.5 cm(2)) was approximately 36% smaller than that observed at the ESD operation site (8.1 +/- 1.9 cm(2)) (p = 0.05). Epithelialization in the margin and healing of the gastric ulcers were confirmed by microscopy. Conclusions TU-ESD with SBLND is a feasible and safe method. The upper posterior gastric body could be the most feasible location for performing TU-ESD, perhaps because of the difference in the subcutaneous dissection time.
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