Laser-supported diaphanoscopy: a new technique in laparoscopic-endoscopic rendezvous procedures allowing better and more tissue-sparing tumor resection than wedge resection

Laparoscopic-endoscopic Rendezvous Procedures for Upper Gastrointestinal Tumors Guided by Laser-supported Reverse Diaphanoscopy: A Modified Technique

INTRODUCTION

Precisely locating benign upper gastrointestinal tumors during laparoscopic-endoscopic surgery remains difficult and inaccurate. We describe reverse laser-supported diaphanoscopy (RLSD) for locating gastrointestinal tumors during laparoscopic surgery and present prospective evaluation results of the first cases.

MATERIALS AND METHODS

We studied 13 patients [women:men=7:6; mean age, 67 (range, 41 to 83) y] who underwent gastroscopic-laparoscopic rendezvous procedures during 2015 to 2018. Surgery duration, marking duration, and specimen resection size were recorded. The largest and smallest specimen resection margins were measured.

RESULTS

After locating tumors using RLSD, patients underwent successful resections. Histopathologic examination confirmed 5 cases of gastrointestinal stromal tumor; 3, neuroendocrine tumors; 2, heterotopic pancreatic tissue; 1, leiomyoma; 1, adenoma; 1, hyperplastic polyp. We employed 4 to 6 marks, depending on tumor location and size. The average marking duration was 14 minute (1 to 21 min); the average surgery duration, 73 minute (37 to 143 min). The smallest resection median margin was 2.0 mm (1.0 to 5.0 mm); the largest, 7.0 mm (2.0 to 12.0 mm).

CONCLUSIONS

RLSD precisely locates gastric benign tumors during laparoscopic-endoscopic rendezvous procedures.

Optimal management of GIST tumors located near the gastroesophageal junction: Case report and review of the literature

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There are several endoscopic, laparoscopic and open surgical procedures available for the management of GIST tumors near the GE junction.

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We present a case-report utilizing both endoscopy and laparoscopy to facilitate resection using the non-touch lesion-lifting technique.

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Pathology demonstrated a 4.7 cm GIST. The patient was discharged on post-operative day 3 with no complications.

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We include a full literature review and describe the various combined modalities available for successful resection.

Introduction

The safety and oncologic outcome of laparoscopic gastric GIST resection is well established especially for lesions <5 cm in diameter. The optimal management of GIST tumors near the GE junction remains unclear.

Methods

We present a case-report of a 4.7 cm GIST tumor near the GE junction managed by endoscopically-assisted laparoscopic wedge resection (EAWR). We present a review of the literature highlighting the various combined laparo-endoscopic techniques available.

Results

We used the non-touch lesion-lifting method to laparoscopically resect the GIST tumor under endoscopic guidance. There were no complications and the patient was discharged on postoperative day 3.

Conclusions

Endoscopically-assisted laparoscopic wedge resections are feasible and safe for GIST tumors near the GE junction.