- Email: [email protected]
17. Laparoscopic wedge resection for suspected large (≥5 cm) gastric gastrointestinal stromal tumors
S72 The aim of this study was to evaluate the short-term outcome after robot-assisted esophagectomy with a hand sewn intrathoracic anastomosis (RAMIE Ivor Lewis) in patients with esophageal cancer. Material and methods: All data were prospectively collected into a SPSS-database. Patients that were treated with curative intent for esophageal cancer with RAMIE Ivor Lewis from January 2015 until March 2016 were included. The abdominal phase was performed laparoscopically and the thoracic phase was robot-assisted with a hand sewn anastomosis. Results: In total 30 patients received RAMIE Ivor Lewis, with a maleefemale ratio of 29:1 and a median age of 65 year (range 36e83). Neoadjuvant chemoradiotherapy was given to 97% of the patients. Conversion to an open thoracic or abdominal procedure was not necessary. Median operation-time was 363 min (range 290e450) with a median blood loss of 100 ml (range 50e200). Median postoperative ICU stay was 2 days (range 1e42) and median hospital stay was 11 days (range 8e54). Cardiac complications were seen in 33% (mainly atrial fibrillation) and pneumonia was seen in 40%. One patient (3%) developed a chylothorax which was treated with dietary changes only. Twenty-three percent (7 patients) developed an anastomotic leakage of which 2 patients received a Video-Assisted Thoracoscopic Surgery (VATS). In hospital mortality was 0%. A radical resection was achieved in 93% with a median number of lymph nodes of 21 (range 8e44). Conclusion: Robot-assisted Ivor Lewis esophagectomy in patients with esophageal cancer is safe and effective on short-term. A hand sewn robot-assisted anastomosis is a feasible option with a low postoperative mortality. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.022
17. Laparoscopic wedge resection for suspected large (‡5 cm) gastric gastrointestinal stromal tumors B.K. Goh1, C.Y. Khoo1, A.K. Eng2, W.H. Chan2, M.C. Teo3, A.Y. Chung1, H.S. Ong2, W.K. Wong2 1 Singapore General Hospital, Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore, Singapore 2 Singapore General Hospital, Department of Upper Gastrointestinal Tract and Bariatric Surgery, Singapore, Singapore 3 National Cancer Center Singapore, Surgical Oncology, Singapore, Singapore Background: Laparoscopic wedge resection (LWR) for small gastric gastrointestinal stromal tumors (GIST) is now widely accepted. However, its application for large gastric GISTs remains controversial. This study aims to evaluate the feasibility and safety of LWR for suspected large (5 cm) gastric GISTs. Methods: This is a retrospective review of 82 consecutive patients who underwent attempted LWR for a suspected gastric GIST at a single institution between 2002 and 2015. The patients were stratified into large (5 cm) (n ¼ 23) and small (<5 cm) tumors (n ¼ 59). The 23 patients who underwent LWR of large tumors were also compared to 36 consecutive patients who underwent open wedge resection (OWR) of large tumors. Results: Comparison between the outcomes of patients who underwent LWR for large versus small tumors demonstrated that resection of large tumors was associated with a longer operating time [210(150e475) vs 140(60e415) min, P < 0.001]. There was no difference in other perioperative outcomes, and oncological outcomes such as frequency of close margins (1 mm) and recurrence-free survival. Comparison between patients who underwent LWR versus OWR for large tumors showed that LWR was associated with decreased median time to fluid diet [2(1e4) vs 3(1e6) days, P < 0.001], decreased median time to solid diet [3(1e9) vs 5(2e9) days, P < 0.001], shorter postoperative stay [4(2e72) vs 7.5(4e64) days, P < 0.001] but longer operating times [210(150e475 vs 105(50e245) min, P < 0.001]. There was no difference in oncological outcomes between LWR and OWR.
ABSTRACTS Conclusion: LWR for large gastric GIST (5 cm) is feasible and safe. It is associated with the same favorable short-term outcomes over OWR as LWR for small tumors without compromising on oncological outcomes. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.023
18. A pilot study evaluating the overlay display method for image guidance in laparoscopic liver surgery C. Schneider1, S. Thompson2, J. Totz2, Y. Song2, K. Gurusamy1, S. Ourselin2, D. Stoyanov2, M.J. Clarkson2, D.J. Hawkes2, B.R. Davidson2 1 University College London, Division of Surgery & Interventional Science, London, United Kingdom 2 University College London, Centre for Medical Image Computing, London, United Kingdom Introduction: Despite reported benefits in terms of reduced morbidity and improved recovery, laparoscopic liver resection (LLR) has not been widely adopted. Image guidance systems that display a 3D model of the liver during surgery were introduced to alleviate some of the technical difficulties of LLR. Current systems however are cumbersome because they use two separate screens to display the laparoscopic site next to the 3D model and because they require users to manually align the 3D model with in-situ anatomy. To address this issue an image guidance system (SmartLiver) has been developed that displays information like a headup display by directly overlaying the 3D model onto the laparoscopic screen. SmartLiver was evaluated in a clinical study, and for the first time in humans, the feasibility of employing image reconstruction technology to automatically align 3D model with patient anatomy, is demonstrated. Methods: Patients undergoing LLR or staging laparoscopy were eligible for recruitment. SmartLiver has three key components: 1) a 3D liver model, 2) tracking of the laparoscope position and 3) alignment of 3D model and in-situ anatomy. The 3D model was constructed from a preoperative CT scan. Changes in laparoscope position were determined by fitting it with infrared markers that were tracked by a 3D tracking camera positioned above the operating table. The 3D model was aligned manually and automatically. The latter was achieved by using triangulation with a 3D laparoscope at surgery matching the liver surface to the shape of the 3D model. The overlay accuracy of SmartLiver was measured by evaluating the discrepancy between anatomical landmarks as displayed on the 3D model in comparison to the laparoscopic video. At completion of the procedure, surgeons were asked to complete a usability survey. Results: In total 6 patients undergoing LLR and 8 patients undergoing staging laparoscopy were recruited for the study. Due to technical or surgical issues, image overlay could not be achieved in 5 patients. Median accuracy for manual alignment was 11 6 mm (standard deviation). In one patient an automatic alignment was successfully processed in the lab with data obtained during surgery. The overlay accuracy was 8 mm compared to 11 mm for the intraoperative, manual alignment carried out in the same patient. Surgeon feedback will be included in the full presentation. Discussion: Intraoperative use of SmartLiver was found to be feasible. Its key advantage is the overlay display which facilitates intuitive interpretation of the anatomical situation. Accuracy is being improved but because SmartLiver is the first system of its kind, there is no comparative data in the literature. A new study is being carried out to assess if automatic alignment performed during surgery can improve accuracy and to test the usability of a simplified graphic user interface. Conflict of interest: Board of Directors: Prof. Hawkes is a co-founder of IXICO Ltd. http://dx.doi.org/10.1016/j.ejso.2016.06.024
17. Laparoscopic wedge resection for suspected large (‡5 cm) gastric gastrointestinal stromal tumors B.K. Goh1, C.Y. Khoo1, A.K. Eng2, W.H. Chan2, M.C. Teo3, A.Y. Chung1, H.S. Ong2, W.K. Wong2 1 Singapore General Hospital, Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore, Singapore 2 Singapore General Hospital, Department of Upper Gastrointestinal Tract and Bariatric Surgery, Singapore, Singapore 3 National Cancer Center Singapore, Surgical Oncology, Singapore, Singapore Background: Laparoscopic wedge resection (LWR) for small gastric gastrointestinal stromal tumors (GIST) is now widely accepted. However, its application for large gastric GISTs remains controversial. This study aims to evaluate the feasibility and safety of LWR for suspected large (5 cm) gastric GISTs. Methods: This is a retrospective review of 82 consecutive patients who underwent attempted LWR for a suspected gastric GIST at a single institution between 2002 and 2015. The patients were stratified into large (5 cm) (n ¼ 23) and small (<5 cm) tumors (n ¼ 59). The 23 patients who underwent LWR of large tumors were also compared to 36 consecutive patients who underwent open wedge resection (OWR) of large tumors. Results: Comparison between the outcomes of patients who underwent LWR for large versus small tumors demonstrated that resection of large tumors was associated with a longer operating time [210(150e475) vs 140(60e415) min, P < 0.001]. There was no difference in other perioperative outcomes, and oncological outcomes such as frequency of close margins (1 mm) and recurrence-free survival. Comparison between patients who underwent LWR versus OWR for large tumors showed that LWR was associated with decreased median time to fluid diet [2(1e4) vs 3(1e6) days, P < 0.001], decreased median time to solid diet [3(1e9) vs 5(2e9) days, P < 0.001], shorter postoperative stay [4(2e72) vs 7.5(4e64) days, P < 0.001] but longer operating times [210(150e475 vs 105(50e245) min, P < 0.001]. There was no difference in oncological outcomes between LWR and OWR.
ABSTRACTS Conclusion: LWR for large gastric GIST (5 cm) is feasible and safe. It is associated with the same favorable short-term outcomes over OWR as LWR for small tumors without compromising on oncological outcomes. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.023
18. A pilot study evaluating the overlay display method for image guidance in laparoscopic liver surgery C. Schneider1, S. Thompson2, J. Totz2, Y. Song2, K. Gurusamy1, S. Ourselin2, D. Stoyanov2, M.J. Clarkson2, D.J. Hawkes2, B.R. Davidson2 1 University College London, Division of Surgery & Interventional Science, London, United Kingdom 2 University College London, Centre for Medical Image Computing, London, United Kingdom Introduction: Despite reported benefits in terms of reduced morbidity and improved recovery, laparoscopic liver resection (LLR) has not been widely adopted. Image guidance systems that display a 3D model of the liver during surgery were introduced to alleviate some of the technical difficulties of LLR. Current systems however are cumbersome because they use two separate screens to display the laparoscopic site next to the 3D model and because they require users to manually align the 3D model with in-situ anatomy. To address this issue an image guidance system (SmartLiver) has been developed that displays information like a headup display by directly overlaying the 3D model onto the laparoscopic screen. SmartLiver was evaluated in a clinical study, and for the first time in humans, the feasibility of employing image reconstruction technology to automatically align 3D model with patient anatomy, is demonstrated. Methods: Patients undergoing LLR or staging laparoscopy were eligible for recruitment. SmartLiver has three key components: 1) a 3D liver model, 2) tracking of the laparoscope position and 3) alignment of 3D model and in-situ anatomy. The 3D model was constructed from a preoperative CT scan. Changes in laparoscope position were determined by fitting it with infrared markers that were tracked by a 3D tracking camera positioned above the operating table. The 3D model was aligned manually and automatically. The latter was achieved by using triangulation with a 3D laparoscope at surgery matching the liver surface to the shape of the 3D model. The overlay accuracy of SmartLiver was measured by evaluating the discrepancy between anatomical landmarks as displayed on the 3D model in comparison to the laparoscopic video. At completion of the procedure, surgeons were asked to complete a usability survey. Results: In total 6 patients undergoing LLR and 8 patients undergoing staging laparoscopy were recruited for the study. Due to technical or surgical issues, image overlay could not be achieved in 5 patients. Median accuracy for manual alignment was 11 6 mm (standard deviation). In one patient an automatic alignment was successfully processed in the lab with data obtained during surgery. The overlay accuracy was 8 mm compared to 11 mm for the intraoperative, manual alignment carried out in the same patient. Surgeon feedback will be included in the full presentation. Discussion: Intraoperative use of SmartLiver was found to be feasible. Its key advantage is the overlay display which facilitates intuitive interpretation of the anatomical situation. Accuracy is being improved but because SmartLiver is the first system of its kind, there is no comparative data in the literature. A new study is being carried out to assess if automatic alignment performed during surgery can improve accuracy and to test the usability of a simplified graphic user interface. Conflict of interest: Board of Directors: Prof. Hawkes is a co-founder of IXICO Ltd. http://dx.doi.org/10.1016/j.ejso.2016.06.024