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Feasibility of the trans-umbilical route compared with the trans-oral route in gastric upper body endoscopic submucosal dissection: a porcine model

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Abstract

Background

Total gastrectomy is performed for early gastric cancer in the upper body of the stomach because of the high complication rate of endoscopic submucosal dissection (ESD). The aims of the present animal study in pigs were to verify: (1) the feasibility of the trans-umbilical route compared with the trans-oral route in gastric upper body ESD; (2) the non-inferiority of single port laparoscopic lymph node dissection (LLND) compared with multiport LLND; and (3) the safety of 2-basin LLND (upper greater and lesser curvature).

Methods

We separated the pigs (~40 kg each) into two groups: conventional and experimental (n = 5 per group). We performed ESD in the fundus and upper body anterior wall (UBAW) via the trans-oral route and multiport LLND in the conventional group, and via the trans-umbilical route and single port LLND in the experimental group.

Results

The completion rates, tissue weights, and specimen diameters of both routes showed no statistical differences in either the fundus or the UBAW. The operative time was shorter with the trans-umbilical route than with the trans-oral route in both areas (p < 0.05). In LLND, there were no differences in surgical outcomes between the multiport and single port groups. Intraoperative perforation was seen in the trans-oral route group (n = 1). Delayed perforation was observed in 30 % of the ESD sites.

Conclusions

The trans-umbilical route is feasible and has lower complication rates than the trans-oral route in gastric upper body ESD. Additionally, single port LLND is not inferior to multiport LLND, and one-side-basin dissection is safer than two-side.

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Acknowledgments

The authors are grateful to Sang-U Kim, RN, Hae-Chul Park, RN, in the Gyungsang National University Hospital for assisting at the operation, and to HyunJhung Jhun, DVM, Soon Nam Choi, RN, and all the staff of the Laboratory Animal Research Center, Konkuk University, for conducting experiments. This work was supported by Gyungsang National University Hospital Clinical Research Fund (GNUHCRF-2012-002). The authors are grateful to Covidien for funding and support with laparoscopic instruments, Olympus for support with the endoscope, and Dalim Surg Net for support with the OCTO Port.

Disclosure

Drs. Sang-Ho Jeong, Ji-Ho Park, Moon-Won Yoo, Sang-Kyung Choi, Soon-Chan Hong, Eun-Jung Jung, Young-Tae Ju, Chi-Young Jeong, Woo-Song Ha, Chang Yoon Ha, and Young-Joon Lee have no conflicts of interest or financial ties to disclose.

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Author notes

  1. Moon-Won Yoo

    Present address: Department of Surgery, Asan Medical Center, Seoul, South Korea

Authors and Affiliations

  1. Department of Surgery, Gyeongsang National University, 90 Chilam-dong, Jinju, Gyeongsang South Province, 660-702, South Korea

    Sang-Ho Jeong, Ji-Ho Park, Sang-Kyung Choi, Soon-Chan Hong, Eun-Jung Jung, Young-Tae Ju, Chi-Young Jeong, Woo-Song Ha & Young-Joon Lee

  2. Department Internal Medicine of Postgraduate School of Medicine, Gyeongsang National University, 90 Chilam-dong, Jinju, Gyeongsang South Province, 660-702, South Korea

    Chang Yoon Ha

  3. Gyeongnam Regional Cancer Center, Gyeongsang National University Hospital, Jinju, South Korea

    Sang-Ho Jeong, Ji-Ho Park, Sang-Kyung Choi, Soon-Chan Hong, Eun-Jung Jung, Young-Tae Ju, Chi-Young Jeong, Woo-Song Ha, Chang Yoon Ha & Young-Joon Lee

  4. Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea

    Sang-Ho Jeong, Ji-Ho Park, Sang-Kyung Choi, Soon-Chan Hong, Eun-Jung Jung, Young-Tae Ju, Chi-Young Jeong, Woo-Song Ha, Chang Yoon Ha & Young-Joon Lee

  5. Department of Surgery, Konkuk University, Seoul, South Korea

    Moon-Won Yoo

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  1. Sang-Ho Jeong
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Correspondence to Chang Yoon Ha or Young-Joon Lee.

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Jeong, SH., Park, JH., Yoo, MW. et al. Feasibility of the trans-umbilical route compared with the trans-oral route in gastric upper body endoscopic submucosal dissection: a porcine model. Surg Endosc 28, 515–523 (2014). https://doi.org/10.1007/s00464-013-3196-9

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  • DOI: https://doi.org/10.1007/s00464-013-3196-9

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