Laparoscopic Intraluminal Surgery for Gastrointestinal Malignancies



Intraluminal surgery began with the advent of endoscopy. Endoscopic endoluminal surgery has limitations; and its failure results in conventional open or laparoscopic interventions with increased morbidity. Laparoscopy-assisted intraluminal surgery is a novel alternative to open or laparoscopic surgery for a failed endoscopic endoluminal technique, minimizing the associated complications. Endoscopic resection of early gastric and duodenal cancers is restricted by the limited view of the endoscope, insufficient number of instrument channels, and inability to have adequate margins of resection without risking perforation. These cancers potentially can be treated by laparoscopy-assisted intraluminal surgery without resorting to major gastric or duodenal resection. This procedure is relatively easy to perform and oncologically effective. We present the experience of the Texas Endosurgery Institute (TEI) in treating early gastric and duodenal cancers, including large malignant polyps and carcinoid tumors, with laparoscopy-assisted endoluminal surgery.

Materials and methods

The data for all patients with early gastric and duodenal cancers who underwent laparoscopy-assisted endoluminal surgery at TEI between 1996 and 2007 were prospectively recorded. All of the patients had been referred by the endoscopist as noncandidates for endoscopic resection. We prospectively collected data on preoperative diagnosis, operating time, estimated blood loss, postoperative complications, histopathology, and recurrence rate. All patients underwent endoluminal port placement under direct visualization after a pneumoperitoneum was established. Operations were performed in conjunction with upper endoscopy for assistance with port placement under endoluminal visualization, insufflation, and specimen retrieval. After the intraluminal portion of the operation was completed, the endoluminal port sites were closed with laparoscopic intracorporeal suturing.


From 1996 to 2007, a total of 12 patients underwent laparoscopic endoluminal surgery. All cases were completed successfully, including 5 resections of early gastric cancer (stage I), 3 wedge resections of carcinoid tumor, 2 resections of duodenal adenocarcinoma, and 2 resections of a malignant polyp at the gastroesophagic junction; all the cases were completed with disease-free margins. No recurrence of the original pathology have been reported, and the complications were minimal.


Laparoscopic intraluminal surgery for early gastric and duodenal cancer is a feasible alternative to open conventional therapies; and it is associated with a lower incidence of incisional hernia formation and a lower infection rate.

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  1. 1.

    Ponsky JL (2006) Endoluminal surgery: past, present and future. Surg Endosc 20(Suppl 2):S500–S502

  2. 2.

    Rosen MJ, Heniford BT (2005) Endoluminal gastric surgery: the modern era of minimally invasive surgery. Surg Clin North Am 85:989–1007, vii

  3. 3.

    Cuschieri A (2006) Laparoscopic surgery in Europe: where are we going? Cir Esp 79:10–21

  4. 4.

    Bhoyru S, Way LW (1995) Intraluminal gastric surgery. In: Duh Q-Y (ed). Laparoscopic surgery: laparoscopic access to the gastrointestinal tract. Decker Medical Publications, King of Prussia, PA, pp 189–197

  5. 5.

    Tomonaga T, Houghton S, Filipi C et al (1999) A new form of access for endo-organ surgery: the initial experience with percutaneous endoscopic gastrostomy. Surg Endosc 13:738–741

  6. 6.

    Martinez-Serna T, Filipi CJ (1999) Endoluminal surgery. World J Surg 23:368–377

  7. 7.

    Spivak H, Hunter JG (1997) Endoluminal surgery. Surg Endosc 11:321–325

  8. 8.

    Lai DT, Chu KM, Storey DW (1996) Laparoscopic endoluminal gastric surgery. Aust N Z J Surg 66:41–42

  9. 9.

    Iwase K, Higaki J, Tanaka Y et al (1999) Laparoscopic intragastric resection of gastric leiomyoma close to the cardia using a flexible endocutter intraluminally. Eur J Surg 165:1203–1205

  10. 10.

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

  11. 11.

    Piskun G, Fleites JC, Shaftan GW et al (1998) A laparoscopic approach to posterior gastric wall leiomyomectomy. J Laparoendosc Adv Surg Tech A 8:75–78

  12. 12.

    Seelig MH, Hinder RA, Floch NR et al (1999) Endo-organ and laparoscopic management of gastric leiomyomas. Surg Laparosc Endosc 9:78–81

  13. 13.

    Tomonaga T, Filipi CJ, Marsh RE et al (1999) Endo-organ full-thickness excision for gastric cancer: report of a case. Surg Today 29:1248–1252

  14. 14.

    Scott-Conner CE (2002) Laparoscopic gastrointestinal surgery. Med Clin North Am 86:1401–1422

  15. 15.

    Tanabe S, Koizumi W, Mitomi H et al (2002) Clinical outcome of endoscopic aspiration mucosectomy for early gastric cancer. Gastrointest Endosc 56:708–713

  16. 16.

    Mori T, Abe N, Sugiyama M et al (2000) Laparoscopic pancreatic cystgastrostomy. J Hepatobiliary Pancreat Surg 7:28–34

  17. 17.

    Mori T, Bhoyrul S, Way LW (1994) Laparoscopic pancreatic cystogastrostomy: the first operation in the new field of endoluminal laparoscopic surgery. Surg Endosc 8:448

  18. 18.

    Yamashita Y, Maekawa T, Sakai T et al (1999) Transgastrostomal endoscopic surgery for early gastric carcinoma and submucosal tumor. Surg Endosc 13:361–364

  19. 19.

    Franklin ME Jr, Díaz-E JA, Abrego D et al (2000) Laparoscopic-assisted colonoscopic polypectomy: the Texas Endosurgery Institute experience. Dis Colon Rectum 43:1246–1249

  20. 20.

    Franklin ME Jr, Leyva-Alvizo A, Abrego-Medina D et al (2007) Laparoscopically monitored colonoscopic polypectomy: an established form of endoluminal therapy for colorectal polyps. Surg Endosc 21:1650–1653

  21. 21.

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

  22. 22.

    Watson DI, Game PA, Devitt PG (1996) Laparoscopic resection of benign tumors of the posterior gastric wall. Surg Endosc 10:540–541

  23. 23.

    Basso N, Silecchia G, Pizzuto G et al (1996) Laparoscopic excision of posterior gastric wall leiomyoma. Surg Laparosc Endosc 6:65–67

  24. 24.

    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

  25. 25.

    Park YS, Park SW, Kim TI et al (2004) Endoscopic enucleation of upper GI submucosal tumors by using an insulated-tip electrosurgical knife. Gastrointest Endosc 59:409–415

  26. 26.

    Lee IL, Lin PY, Tung SY et al (2006) Endoscopic submucosal dissection for the treatment of intraluminal gastric subepithelial tumors originating from the muscularis propria layer. Endoscopy 38:1024–1028

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Correspondence to Guillermo Portillo.

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Franklin, M.E., Portillo, G., Treviño, J.M. et al. Laparoscopic Intraluminal Surgery for Gastrointestinal Malignancies. World J Surg 32, 1709 (2008).

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  • Early Gastric Cancer
  • Carcinoid Tumor
  • Endoscopic Resection
  • Anterior Abdominal Wall
  • Duodenal Cancer