Skip to main content
SpringerLink
Log in

Comparison of minilaparoscopy and single-incision intragastric surgery for gastric submucosal tumor resection in a porcine model

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The aim of this study was to develop an easy-to-induce and reproducible model of gastric submucosal tumor in swine to compare minilaparoscopy (ML) with single-incision (SI) intragastric surgery.

Methods

Twelve healthy female pigs (weight 30.94 ± 2.49 kg) underwent a transparietal injection of sterile alginate at the level of Z-line (n = 6) and at the pre-pyloric area (n = 6) creating a model of gastric submucosal pseudotumor. The operative procedures included intragastric resection with ML and SI approaches of cardiac and pre-pyloric lesions, with gastroscopic assistance. After resection, the gastric mucosal layer was closed using intracorporeal sutures. The operative time, complication rate and clinical evolution after 1 month were compared in the four groups that the pigs were arranged.

Results

The pseudotumors ranged in size from 3 to 6 cm in diameter. The access of the gastric cavity and resection of the experimental SMP and suturing of the mucosa were performed successfully in 12 animals using both approaches. Mean time to perform the exeresis of gastric cardia tumors was significantly higher in single-incision approach. No significant differences were observed in the surgical time during pyloric surgery. Minilaparoscopic approach reduced significantly the mucosa closure time in esophagogastric and pyloric pseudotumors. One month after, no alterations were shown in the abdominal cavity using exploratory laparotomy.

Conclusions

The technical feasibility of performing safe and efficient intragastric approach of submucosal pseudotumors in swine model was verified in this study. Intragastric ML has advantages over SI, namely regarding the reduction in total surgical times and the fewer technical difficulties.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Novitsky YW, Kercher KW, Sing RF et al (2006) Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg 243:738–745 discussion 745-7

    Article  PubMed  PubMed Central  Google Scholar 

  2. Otani Y, Furukawa T, Yoshida M et al (2006) Operative indications for relatively small (2–5 cm) gastrointestinal stromal tumor of the stomach based on analysis of 60 operated cases. Surgery 139:484–492

    Article  PubMed  Google Scholar 

  3. Sexton JA, Pierce RA, Halpin VJ et al (2008) Laparoscopic gastric resection for gastrointestinal stromal tumors. Surg Endosc 22:2583–2587

    Article  PubMed  Google Scholar 

  4. Wilhelm D, von Delius S, Burian M et al (2008) Simultaneous use of laparoscopy and endoscopy for minimally invasive resection of gastric subepithelial masses—analysis of 93 interventions. World J Surg 32:1021–1028

    Article  CAS  PubMed  Google Scholar 

  5. Sasaki A, Koeda K, Obuchi T et al (2010) Tailored laparoscopic resection for suspected gastric gastrointestinal stromal tumors. Surgery 147:516–520

    Article  PubMed  Google Scholar 

  6. Schubert D, Kuhn R, Nestler G et al (2005) Laparoscopic-endoscopic rendezvous resection of upper gastrointestinal tumors. Dig Dis 23:106–112

    Article  CAS  PubMed  Google Scholar 

  7. Roggin KK, Posner MC (2012) Modern treatment of gastric gastrointestinal stromal tumors. World J Gastroenterol 18:6720–6728

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ludwig K, Klautke G, Bernhard J et al (2005) Minimally invasive and local treatment for mucosal early gastric cancer. Surg Endosc 19:1362–1366

    Article  CAS  PubMed  Google Scholar 

  9. Probst A, Messmann H (2009) Endoscopic therapy for early gastric cancers—from EMR to ESD, from guideline criteria to expanded criteria. Digestion 80:170–172

    Article  PubMed  Google Scholar 

  10. Conrad C, Nedelcu M, Ogiso S et al (2014) Laparoscopic intragastric surgery for early gastric cancer and gastrointestinal stromal tumors. Ann Surg Oncol 21:2620

    Article  PubMed  Google Scholar 

  11. Shim JH, Lee HH, Yoo HM et al (2011) Intragastric approach for submucosal tumors located near the Z-line: a hybrid laparoscopic and endoscopic technique. J Surg Oncol 104:312–315

    Article  PubMed  Google Scholar 

  12. Lamm SH, Steinemann DC, Linke GR et al (2015) Total inverse transgastric resection with transoral specimen removal. Surg Endosc 29(11):3363–3366

    Article  PubMed  Google Scholar 

  13. Mino JS, Guerron AD, Monteiro R et al (2015) Long-term outcomes of combined endoscopic/laparoscopic intragastric enucleation of presumed gastric stromal tumors. Surg Endosc. doi:10.1007/s00464-015-4416-2

    PubMed  Google Scholar 

  14. Kong J, Wu SD, Su Y et al (2014) Single incision versus conventional laparoscopic resection in gastrointestinal stromal tumors: a retrospective cohort analysis at a single tertiary care center. Onco Targets Ther 7:995–999

    PubMed  PubMed Central  Google Scholar 

  15. Barajas-Gamboa JS, Acosta G, Savides TJ et al (2015) Laparo-endoscopic transgastric resection of gastric submucosal tumors. Surg Endosc 29:2149–2157

    Article  PubMed  Google Scholar 

  16. Abe N, Izumisato Y, Yamaguchi Y et al (2005) En bloc endoscopic mucosal resection of a large early stage gastric cancer by combined use of an insulation-tipped diathermic knife and a grasping forceps percutaneously inserted into the gastric lumen. Hepatogastroenterology 52:1301–1304

    PubMed  Google Scholar 

  17. Matthews BD, Walsh RM, Kercher KW et al (2002) Laparoscopic vs open resection of gastric stromal tumors. Surg Endosc 16:803–807

    Article  CAS  PubMed  Google Scholar 

  18. Tagaya N, Tatsuoka T, Kubota Y et al (2015) Intragastric surgery using laparoscopy and oral endoscopy for gastric submucosal tumors. World J Gastrointest Endosc 7:53–58

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ohashi S (1995) Laparoscopic intraluminal (intragastric) surgery for early gastric cancer. A new concept in laparoscopic surgery. Surg Endosc 9:169–171

    Article  CAS  PubMed  Google Scholar 

  20. Tagaya N, Mikami H, Kogure H et al (2002) Laparoscopic intragastric stapled resection of gastric submucosal tumors located near the esophagogastric junction. Surg Endosc 16:177–179

    Article  CAS  PubMed  Google Scholar 

  21. Taniguchi E, Kamiike W, Yamanishi H et al (1997) Laparoscopic intragastric surgery for gastric leiomyoma. Surg Endosc 11:287–289

    Article  CAS  PubMed  Google Scholar 

  22. Kilkenny C, Browne WJ, Cuthill IC et al (2010) Improving bioscience research reporting: the ARRIVE guidelines for reporting animal research. PLoS Biol 8:e1000412

    Article  PubMed  PubMed Central  Google Scholar 

  23. Council NR (2010) Guide for care and use of laboratory animals. The National Academies Press, Washington, DC

    Google Scholar 

  24. Lee JH, Han HS (2005) A prospective randomized study comparing open vs laparoscopy-assisted distal gastrectomy in early gastric cancer: early results. Surg Endosc 19:168–173

    Article  PubMed  Google Scholar 

  25. Karakousis GC, Singer S, Zheng J et al (2011) Laparoscopic versus open gastric resections for primary gastrointestinal stromal tumors (GISTs): a size-matched comparison. Ann Surg Oncol 18:1599–1605

    Article  PubMed  PubMed Central  Google Scholar 

  26. Conrad C, Nedelcu M, Ogiso S et al (2015) Techniques of intragastric laparoscopic surgery. Surg Endosc 29:202–206

    Article  PubMed  Google Scholar 

  27. Nguyen SQ, Divino CM, Wang JL et al (2006) Laparoscopic management of gastrointestinal stromal tumors. Surg Endosc 20:713–716

    Article  CAS  PubMed  Google Scholar 

  28. Zhu JF, Xin Y, Ma YZ et al (2012) Single-port laparoscopic intragastric surgery using SILS port: a feasibility study on a porcine model. Surg Innov 19:236–240

    Article  PubMed  Google Scholar 

  29. DeMatteo RP, Lewis JJ, Leung D et al (2000) Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 231:51–58

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Huguet KL, Rush RM Jr, Tessier DJ et al (2008) Laparoscopic gastric gastrointestinal stromal tumor resection: the mayo clinic experience. Arch Surg 143:587–590 discussion 591

    Article  PubMed  Google Scholar 

  31. Xu X, Chen K, Zhou W et al (2013) Laparoscopic transgastric resection of gastric submucosal tumors located near the esophagogastric junction. J Gastrointest Surg 17:1570–1575

    Article  PubMed  Google Scholar 

  32. Ibrahim IM, Silvestri F, Zingler B (1997) Laparoscopic resection of posterior gastric leiomyoma. Surg Endosc 11:277–279

    Article  CAS  PubMed  Google Scholar 

  33. Aogi K, Hirai T, Mukaida H et al (1999) Laparoscopic resection of submucosal gastric tumors. Surg Today 29:102–106

    Article  CAS  PubMed  Google Scholar 

  34. Abe N, Takeuchi H, Yanagida O et al (2009) Endoscopic full-thickness resection with laparoscopic assistance as hybrid NOTES for gastric submucosal tumor. Surg Endosc 23:1908–1913

    Article  PubMed  Google Scholar 

  35. Tagaya N, Mikami H, Kubota K (2004) Laparoscopic resection of gastrointestinal mesenchymal tumors located in the upper stomach. Surg Endosc 18:1469–1474

    Article  CAS  PubMed  Google Scholar 

  36. Choi YB, Oh ST (2000) Laparoscopy in the management of gastric submucosal tumors. Surg Endosc 14:741–745

    Article  CAS  PubMed  Google Scholar 

  37. Wiech T, Walch A, Werner M (2005) Histopathological classification of nonneoplastic and neoplastic gastrointestinal submucosal lesions. Endoscopy 37:630–634

    Article  CAS  PubMed  Google Scholar 

  38. Morales-Conde S, Alarcon I, Ortiz-Moyano C et al (2013) Intragastric endoscopic assisted single incision surgery for gastric leiomyoma of the esophagogastric junction. Case Rep Gastrointest Med 2013:391430. doi:10.1155/2013/391430

    PubMed  PubMed Central  Google Scholar 

  39. Rohatgi A, Singh KK (2003) Laparoendoscopic management of gastrointestinal stromal tumors. J Laparoendosc Adv Surg Tech A 13:37–40

    Article  PubMed  Google Scholar 

  40. Son T, Inaba K, Woo Y et al (2011) New surgical approach for gastric bezoar: “hybrid access surgery” combined intragastric and single port surgery. J Gastric Cancer 11:230–233

    Article  PubMed  PubMed Central  Google Scholar 

  41. Na JU, Lee SI, Noh SM (2011) The single incision laparoscopic intragastric wedge resection of gastric submucosal tumor. J Gastric Cancer 11:225–229

    Article  PubMed  PubMed Central  Google Scholar 

  42. Sasaki A, Nitta H, Otsuka K et al (2014) Single-port versus multiport laparoscopic resection for gastric gastrointestinal stromal tumors: a case-matched comparison. Surg Today 44:1282–1286

    Article  PubMed  Google Scholar 

  43. De Vogelaere K (2014) GIST of stomach: an update on surgery. Minerva Chir 69:347–362

    PubMed  Google Scholar 

  44. Choi CI, Lee SH, Hwang SH et al (2014) Single-incision intragastric resection for upper and mid gastric submucosal tumors: a case-series study. Ann Surg Treat Res 87:304–310

    Article  PubMed  PubMed Central  Google Scholar 

  45. Heniford BT, Arca MJ, Walsh RM (2000) The mini-laparoscopic intragastric resection of a gastroesophageal stromal tumor: a novel approach. Surg Laparosc Endosc Percutan Tech 10:82–85

    CAS  PubMed  Google Scholar 

  46. Madan AK, Frantzides CT, Keshavarzian A et al (2004) Laparoscopic wedge resection of gastric leiomyoma. JSLS 8:77–80

    PubMed  PubMed Central  Google Scholar 

  47. Walsh RM, Heniford BT (2001) Laparoendoscopic treatment of gastric stromal tumors. Semin Laparosc Surg 8:189–194

    Article  CAS  PubMed  Google Scholar 

  48. Swindle MM, Makin A, Herron AJ et al (2012) Swine as models in biomedical research and toxicology testing. Vet Pathol 49:344–356

    Article  CAS  PubMed  Google Scholar 

  49. Kobayashi E, Hishikawa S, Teratani T et al (2012) The pig as a model for translational research: overview of porcine animal models at Jichi Medical University. Transplant Res 1(1):8

    Article  PubMed  PubMed Central  Google Scholar 

  50. Tapia-Vega MA, Morales-Chavez CE, Aguirre-Olmedo I et al (2014) Transgastric laparo-endoscopic approach for difficult access lesions. Experimental mode. Cir Cir 82:150–156

    PubMed  Google Scholar 

  51. Kong SH, Yang HK (2013) Surgical treatment of gastric gastrointestinal stromal tumor. J Gastric Cancer 13:3–18

    Article  PubMed  PubMed Central  Google Scholar 

  52. Sanchez-Margallo FM, Sanchez-Hurtado MA, Perez-Duarte FJ et al (2013) Training and research in urologic laparoscopic surgery. Design of training programs and experimental models of renal tumor. Arch Esp Urol 66:33–40

    PubMed  Google Scholar 

  53. Tonouchi H, Mohri Y, Tanaka K et al (2006) Laparoscopic intragastric surgery using GelPort. J Laparoendosc Adv Surg Tech A 16:146–148

    Article  PubMed  Google Scholar 

  54. Hara J, Nakajima K, Takahashi T et al (2012) Laparoscopic intragastric surgery revisited: its role for submucosal tumors adjacent to the esophagogastric junction. Surg Laparosc Endosc Percutan Tech 22:251–254

    Article  PubMed  Google Scholar 

  55. Li VK, Hung WK, Chung CK et al (2008) Laparoscopic intragastric approach for stromal tumours located at the posterior gastric wall. Asian J Surg 31:6–10

    Article  PubMed  Google Scholar 

  56. Maker AV (2013) A technique for laparoendoscopic resection of posterior fundic gastric GISTs without need for a gastrotomy. Ann Surg Oncol 20:4238

    Article  PubMed  Google Scholar 

  57. Sakamoto Y, Sakaguchi Y, Akimoto H et al (2012) Safe laparoscopic resection of a gastric gastrointestinal stromal tumor close to the esophagogastric junction. Surg Today 42:708–711

    Article  PubMed  Google Scholar 

  58. Santambrogio R, Montorsi M, Schubert L et al (2006) Laparoscopic ultrasound-guided resection of gastric submucosal tumors. Surg Endosc 20:1305–1307

    Article  CAS  PubMed  Google Scholar 

  59. Yumiba T, Ito T, Ikushima H et al (2003) Effect of mucosal suture on the healing of mucosal defect in laparoscopic intragastric surgery. Gastric Cancer 6:96–99

    PubMed  Google Scholar 

  60. Uchikoshi F, Ito T, Nishida T et al (2004) Laparoscopic intragastric resection of gastric stromal tumor located at the esophago-cardiac junction. Surg Laparosc Endosc Percutan Tech 14:1–4

    Article  PubMed  Google Scholar 

  61. Huscher CG, Anastasi A, Crafa F et al (2000) Laparoscopic gastric resections. Semin Laparosc Surg 7:26–54

    CAS  PubMed  Google Scholar 

  62. Milas M, Devedija S, Trkulja V (2014) Single incision versus standard multiport laparoscopic cholecystectomy: up-dated systematic review and meta-analysis of randomized trials. Surgeon 12(5):271–289

    Article  PubMed  Google Scholar 

  63. Trastulli S et al (2013) Systematic review and meta-analysis of randomized clinical trials comparing single-incision versus conventional laparoscopic cholecystectomy. Br J Surg 100(2):191–208

    Article  CAS  PubMed  Google Scholar 

  64. Rink AD et al (2015) Single-incision laparoscopic surgery for diverticulitis in overweight patients. Langenbecks Arch Surg 400(7):797–804

    Article  PubMed  Google Scholar 

  65. Weiss HG et al (2014) Wound complications in 1145 consecutive transumbilical single-incision laparoscopic procedures. Ann Surg 259(1):89–95

    Article  PubMed  Google Scholar 

  66. Rao PP, Rao PP, Bhagwat S (2011) Single-incision laparoscopic surgery - current status and controversies. J Minim Access Surg 7(1):6–16

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

The authors would like to acknowledge Ms. Eva Sequeira, for her assistance.

Author information

Authors and Affiliations

  1. Minimally Invasive Surgery Centre Jesús Usón, Ctra. N-521, km 41,8, 10171, Cáceres, Spain

    F. M. Sánchez-Margallo, M. Pérez López & A. Tapia Araya

  2. Surgery Department, University of Extremadura, Cáceres, Spain

    J. M. Usón Casaús

Authors
  1. F. M. Sánchez-Margallo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Pérez López
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Tapia Araya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. M. Usón Casaús
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. M. Sánchez-Margallo.

Ethics declarations

Conflict of interest

F. M. Sánchez-Margallo, M. Pérez López, A. Tapia Araya and J. M. Usón Casaús state no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sánchez-Margallo, F.M., Pérez López, M., Tapia Araya, A. et al. Comparison of minilaparoscopy and single-incision intragastric surgery for gastric submucosal tumor resection in a porcine model. Surg Endosc 30, 4489–4498 (2016). https://doi.org/10.1007/s00464-016-4781-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-016-4781-5

Keywords

Search

Navigation