Accurate, safe, and rapid method of intraoperative tumor identification for totally laparoscopic distal gastrectomy: injection of mixed fluid of sodium hyaluronate and patent blue

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• 作者：Masatoshi Nakagawa (1)
  Kazuhisa Ehara (1)
  Masaki Ueno (1)
  Tsuyoshi Tanaka (1)
  Sachiko Kaida (1)
  Harushi Udagawa (1)
  
• 关键词：Totally laparoscopic distal gastrectomy ; Tumor identification ; Endoscopic marking ; Patent blue ; Sodium hyaluronate
• 刊名：Surgical Endoscopy
• 出版年：2014
• 出版时间：April 2014
• 年：2014
• 卷：28
• 期：4
• 页码：1371-1375
• 全文大小：931 KB
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• 作者单位：Masatoshi Nakagawa (1)
  Kazuhisa Ehara (1)
  Masaki Ueno (1)
  Tsuyoshi Tanaka (1)
  Sachiko Kaida (1)
  Harushi Udagawa (1)
  
  1. Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
  
• ISSN：1432-2218

文摘

Background In totally laparoscopic distal gastrectomy, determining the resection line with safe proximal margins is often difficult, particularly for tumors located in a relatively upper area. This is because, in contrast to open surgery, identifying lesions by palpating or opening the stomach is essentially impossible. This study introduces a useful method of tumor identification that is accurate, safe, and rapid. Methods On the operation day, after inducing general anesthesia, a mixture of sodium hyaluronate and patent blue is injected into the submucosal layer of the proximal margin. When resecting stomach, all marker spots should be on the resected side. In all cases, the proximal margin is examined histologically by using frozen sections during the operation. Results From October 2009 to September 2011, a prospective study that evaluated this method was performed. A total of 34 patients who underwent totally laparoscopic distal gastrectomy were enrolled in this study. Approximately 5?min was required to complete the procedure. Proximal margins were negative in all cases, and the mean?±?standard deviation?length of the proximal margin was 23.5?±?12.8?mm. No side effects, such as allergy, were encountered. Conclusions As a method of tumor identification for totally laparoscopic distal gastrectomy, this procedure appears accurate, safe, and rapid.