A 57-year-old woman with epigastric pain was diagnosed with a 6-cm abdominal cystic lesion of unclear origin on cross-sectional imaging. Endoscopic ultrasound (EUS) demonstrated a unilocular cyst located between the pancreas, gastric wall, and left adrenal gland, with a regular wall filled with dense fluid with multiple hyperechoic floating spots. A 19-G needle was used to puncture the cyst, but no fluid could be aspirated. Therefore, EUS-guided through-the-needle biopsy (EUS-TTNB) was performed. Histological analysis of the retrieved fragments revealed a fibrous wall lined by “respiratory-type” epithelium with ciliated columnar cells, consistent with the diagnosis of a bronchogenic cyst. Laparoscopic excision was performed, and the diagnosis was confirmed based on the findings of the surgical specimen. Abdominal bronchogenic cysts are extremely uncommon, and a definitive diagnosis is commonly obtained after the examination of surgical specimens due to the lack of pathognomonic findings on cross-sectional imaging and poor cellularity on EUS-guided fine-needle aspiration cytology. EUS-TTNB is useful for establishing a preoperative histological diagnosis, thus supporting the decision-making process.
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Background /Aims: The aim of this study was to investigate the use of non-exposure endoscopic wall-inversion surgery (NEWS) and the combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET) in gastric tumors.
Methods We reviewed all cases of NEWS and CLEAN-NET performed in the department of surgery of the Royal Vinohrady Teaching Hospital.
Results Our department performed 12 gastric tumor resections (NEWS, n=10 and CLEAN-NET, n=2) between March 2016 and February 2017. The cases chosen for these resections included predominantly submucosal tumors with no signs of dissemination or local invasion and early gastric carcinomas (T1SM1 and T1M), where tumor location made it impossible to use endoscopic submucosal dissection. R0 resection margins were confirmed in all the cases.
Conclusions NEWS and CLEAN-NET allow en bloc non-exposed full-thickness gastric wall resection in a way that uses a “close first, cut later” approach to prevent seeding of the peritoneal cavity with tumor cells. These mini-invasive techniques combine laparoscopic and endoscopic techniques, and preserve the full function of the stomach.
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Application of NOTES combined with ESD for the treatment of an exogenous gastric stromal tumor: A case report and review of the literature Xiao-Bo Liu, Zi-Ye Gao, Sandeep Pandey, Bao-Zhen Shan, Ping Liu, Chuan-Tao Sun, Sheng-Bao Li, Shu Jin World Academy of Sciences Journal.2020;[Epub] CrossRef
Comparison of Nonexposed Endoscopic Wall-Inversion Surgery with Endoscopic-Navigated Laparoscopic Wedge Resection for Gastric Submucosal Tumours: Results of a Two-Centre Study Jan Hajer, Lukáš Havlůj, Petr Kocián, Günther Klimbacher, Andreas Shamiyeh, Robert Gürlich, Adam Whitley Gastroenterology Research and Practice.2019; 2019: 1. CrossRef
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Laparoscopic wedge resection of the stomach is a widely accepted treatment for primary resectable gastrointestinal stromal tumors (GISTs). However, it is difficult to determine the appropriate incision line from outside of the stomach, and many attempts have been made to avoid unnecessary resection of unaffected gastric tissues. Recently a technique called non-exposed endoscopic wall-inversion surgery (NEWS) was introduced to avoid exposure of GIST to the peritoneum. Here, we describe the first published case of NEWS for GIST of the stomach practiced in Korea.
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Advances of endoscopic and surgical management in gastrointestinal stromal tumors Lei Yue, Yingchao Sun, Xinjie Wang, Weiling Hu Frontiers in Surgery.2023;[Epub] CrossRef
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Non-Exposure Endoscopic-Laparoscopic Cooperative Surgery for Stomach Tumors: First Experience from the Czech Republic Jan Hajer, Lukáš Havlůj, Adam Whitley, Robert Gürlich Clinical Endoscopy.2018; 51(2): 167. CrossRef
Non-exposed endoscopic wall-inversion surgery for a gastrointestinal stromal tumor of the stomach: A case report Prasit Mahawongkajit, Ajjana Techagumpuch, Worapop Suthiwartnarueput Oncology Letters.2017; 14(4): 4746. CrossRef
Background /Aims: Peritoneoscopy allows the clinician to assess the activity of the surface of the liver and helps him to make a prognosis in cases of liver disease by judging the structural changes of the surface. In chromoperitoneoscopy using an intravenous injection of indocyanine green(ICG), hepatic parenchyme is stained after intravenous injection of ICG while interstitial connective tissue, fatty deposition and hepatoma are not. So diagnostic accuracy is, therefore believed to be elevated in chromoperitoneoscopy than conventional peritoneoscopy or blind liver biopsy. This study was performed to assess the clinical usefulness of chromoperitoneoscopy in various chronic liver diseases. Methods: Intravenous ICG was administered at 2 mg/Kg mixed with 20 cc of saline in 30 cases with several kinds of hepatic disorders during conventional peritoneoscopic examinatians. Liver surface was examined 5 minutes after ICG injection. (Korean J Gastrointest Endosc 18: 21-24, 1998)
Background /Aims: Laparoscopic cholecystectomy(LC) has become the new therapeutic gold standard in uncomplicated symptomatic gallbladder stone. However, some patients with gallstones may be associated with bile duct stones or other biliary pathology. LC is not ideal for removal and evaluation of biliary duct stones even with advocated techniques. Although ERCP is the best way to demonstrate the biliary tree, ERCP is an invasive procedure that may causes complications. The aim of this study was to predict the neeessity for ERCP and to determine the indication of ERCP before LC using noninvasive methods of biliary tree associated liver biochemistry(LB) parameters and sonography. Methods: 270 symptomatic gallbladder stone patients were studied by both sonography and LB including total bilirubin, alkaline phophatase, r-glutamyltransferase and amylase. All patients were performd ERCP for evaluation of biliary tree pathology, Patients who were already found to have either tumors or bile duct stones on sonography were excluded. Patients were classified into normal and dilated biliary tree groups by sonographic findings, normal and abnormal LB groups, negative and positive ERCP groups. Positive ERCP were defined by bile duct stones, tumors, stricture and idiopathic common bile duct dilatation over 11 mm. (Korean J Gastrointest Endosc 17: 371- 379, 1997) (continue)
Surgery for a mid-esophageal lesion requires an open thoracotomy, But authors resected out a stenotic thoracic esphageal lesion with laparoscopic instrument without open thoracotomy. The patient was 50 years old woman with a long history of progressive dyaphagia. A small (3 cm in diameter) smooth ovoid submucosal mass lesion was found at 26 cm distal from incisor on both esophagoscopy and esophagogram. Two 5 mm and two 10 mm trocars were inserted into the right pleural cavity under general anesthesia with double lumen endotracheal tube, An induced pneumothorax by insuffulation of CO2 gas made lung collapse and a good exposure of esophagus. Transorally introduced esophagoscope helped to demonstrate the exact location of lesion and also to give a guide at safe excision of mass with prevention of mucosal perforation. The lesion was found to be a congromeration of an inflammed hilar lympnode and hypertorphic esophageal muscle. The entire lesion was carefully dissected from esphageal mucosa and resected out en bloc. A chest tube was introduced through a trocar site. The lung was reinflated immediately. Post-operatively patient was very comfortable. Laparoscopic surgery is very effective and safe, and it could be applied for the resection of lung bullae, benign pulmonary neoplasm and for an excision of benign esophageal tumor.