- Email: [email protected]
Endoscopic full-thickness resection with laparoscopic assistance
Techniques in Gastrointestinal Endoscopy 17 (2015) 112–114
Contents lists available at ScienceDirect
Techniques in Gastrointestinal Endoscopy journal homepage: www.techgiendoscopy.com/locate/tgie
Endoscopic full-thickness resection with laparoscopic assistance Ian W. Folkert, MDn, Robert E. Roses, MD Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, Pennsylvania 19104
a r t i c l e in f o
abstract
Article history: Received 6 April 2015 Accepted 20 June 2015
Endoscopic full-thickness resection of gastrointestinal (GI) tumors has been applied to the management of premalignant, early malignant, and indolent tumors of the GI tract to spare morbidity associated with traditional surgical approaches. Increasingly, a combined laparoscopic-endoscopic approach is being used to treat lesions that are not amenable to endoscopic resection alone. Case reports and small case series have demonstrated utility for lesions such as gastric GI stromal tumors, early gastric carcinomas, small duodenal masses, and colonic polyps or masses. Although promising, further research is necessary to determine the best indications for such an approach, and to compare long-term outcomes to those achieved with more traditional approaches. & 2015 Elsevier Inc. All rights reserved.
Keywords: Endoscopy Laparoscopy Minimally invasive Rendezvous surgery Laparoendoscopic
1. Introduction Endoscopic full-thickness resection (EFTR) of gastrointestinal tumors has been applied to the management of premalignant, early malignant, and indolent tumors of the gastrointestinal (GI) tract to spare morbidity associated with traditional surgical approaches. Similarly, laparoscopic approaches to GI surgery may limit morbidity associated with open surgical approaches. The last decade has witnessed broader application of such approaches. In some instances, however, laparoscopic or endoscopic approaches are not sufficient. A limitation of laparoscopy is the inability to visualize the luminal surface of the GI tract. For example, in the case of endophytic gastric or colonic tumors, accurately locating the lesion without endoscopic assistance may not be possible. Tumors at or near the gastroesophageal junction can also be challenging to resect without compromising the patency of the gastroesophageal junction. Application of full-thickness endoscopic resection, on the contrary, may be limited by poor visualization, or a prohibitive risk of perforation owing to the technical challenges of closure after resection. The limitations of laparoscopy or endoscopy alone have led to the emergence of a combined, so-called laparoendoscopic, cooperative, or rendezvous approach to resection [1,2]. Examples of tumors that may be amenable to a combined endoscopiclaparoscopic approach include gastric GI stromal tumors, early gastric carcinomas, small duodenal masses, and colonic polyps or
The author reports no direct financial interests that might pose a conflict of interest in connection with the submitted manuscript. n Corresponding author. E-mail address: [email protected] (I.W. Folkert). http://dx.doi.org/10.1016/j.tgie.2015.06.004 0049-0172/& 2015 Elsevier Inc. All rights reserved.
masses. Laparoscopy-assisted EFTR has been described for gastric, duodenal, and colonic tumors [3-6]. This review discusses indications, techniques, and outcomes for EFTR of GI tumors with laparoscopic assistance.
2. Techniques In many cases, laparoscopy can be used to surgically close a defect after full-thickness endoscopic resection, especially in difficult anatomical locations with limited intraluminal working space [3,4]. It also allows for mobilization of structures and observation for unintentional perforation or injury to surrounding structures during full-thickness resection. Access is gained to the peritoneal cavity using either an open (Hasson) technique or a Veress needle. Carbon dioxide is used to create pneumoperitoneum, allowing for visualization of intra-abdominal organs as well as safe subsequent port placement. Placement of working ports depends on the location of the lesion and patient body habitus.
3. Gastric lesions Gastric GI stromal tumors, benign, and early malignant tumors of the stomach are increasingly treated with either laparoscopic wedge resection or endoscopic resections. Laparoscopic wedge resections may spare the patient the morbidity of a subtotal or total gastrectomy, while still allowing for resection with negative margins [7,8]. However, some lesions may be anatomically difficult to resect laparoscopically using a linear stapler, making endoscopic resection with laparoscopic assistance a suitable alternative.
I.W. Folkert, R.E. Roses / Techniques in Gastrointestinal Endoscopy 17 (2015) 112–114
A cooperative approach is also particularly helpful for endophytic tumors, which can be difficult to locate using a laparoscopic approach alone. Several authors have described a combined approach to gastric lesions wherein the endoscope is used to dissect circumferentially around the tumor or mass in a submucosal layer. Then, laparoscopy is used to dissect the seromuscular layer three-fourths of the circumference around the mass along the line of endoscopic dissection. After this dissection the tumor is flipped into the abdominal cavity using laparoscopic graspers, and dissected free with simultaneous closure of the gastric wall defect using a laparoscopic stapling device [9,10]. This allows for precise control of the margin around the mass. A variation of this approach is to perform most of the full-thickness seromuscular dissection endoscopically, complete the resection using laparoscopy, and finally to hand-sew the gastric defect closed laparoscopically [5]. Hiki et al reported a series of 7 patients undergoing a combined approach for gastric submucosal tumors using the aforementioned techniques. All 7 patients had uneventful postoperative courses, with successful resection of the tumor in all cases, a mean operating time of 169 minutes, and an average estimated blood loss of 7 cc [9]. Tsujimoto also reported on a series of 20 patients undergoing similar resection of gastric submucosal tumors. All patients in that series underwent successful resection, with minimal blood loss, and no postoperative morbidity or mortality [10]. In a series of 4 patients who had hand-sewn laparoscopic closure performed after endoscopic resection, Abe et al [5] reported no intraoperative or postoperative adverse events and no evidence of leak or abnormal gastric motility on postoperative upper GI.
4. Duodenal Benign and small lesions of the duodenum can be difficult to treat via a minimally invasive approach. Small lesions within the duodenum can be difficult to localize, and the fixed retroperitoneal location of the duodenum allows limited working room for the endoscopist. The thin-walled nature of the duodenum may predispose to inadvertent perforation or injury during endoscopic resection. Laparoscopic assistance allows for mobilization of the duodenum, monitoring for inadvertent injury to surrounding structures during full-thickness resection, and for closure of defects in the duodenal wall created during endoscopic resection. Cooperative surgery for such duodenal lesions may potentially spare patients with benign or indolent disease processes the morbidity of a duodenal or pancreaticoduodenal resection. Tsujimoto et al [4] described a technique using a cap-fitted endoscope to perform full-thickness resection of duodenal carcinoid tumors, with laparoscopic assistance for duodenal mobilization and subsequent closure. As the authors discuss, a combined approach to the resection of such duodenal lesions has several benefits. Laparoscopic resection with a linear stapler device can potentially narrow the lumen of the duodenum, whereas endoscopic resection alone is associated with a risk of suction injury to surrounding structures or inadequate closure of the lumen. The approach described by Tsujimoto involves initial laparoscopic mobilization of the duodenum, followed by endoscopic suction and resection of the lesion under laparoscopic visualization. Laparoscopic hand suturing then closes the defect. Sato described a similar strategy for duodenal carcinoid tumors, employing EFTR under laparoscopic visualization, followed by laparoscopic sentinel lymph node dissection and closure of the duodenal defect [11]. Other case reports describe similar methodology, in some cases using laparoscopy to perform lymph node biopsy at the time of endoscopic resection [12,13].
113
Tsujimoto et al reported a series of 2 patients undergoing cooperative resection for duodenal carcinoid tumor using the techniques described earlier. Both patients were successfully resected, with a mean operating time of 116 minutes, minimal blood loss, and uneventful postoperative courses [4]. Sakon et al also reported a series of 2 patients undergoing combined laparoscopic-endoscopic resection of duodenal lesions. Both patients underwent successful resection of a tubular adenoma, with adequate margins, minimal blood loss, and no postoperative complications [13]. Other single-patient case reports also demonstrate adequate resection and minimal postoperative morbidity with such an approach [3,12].
5. Colonic lesions Endoscopists have been pushing the boundaries of endoscopic resection of colon polyps and masses for many years. Similarly, laparoscopic colon resections are increasingly common, and may lead to faster recovery time and decreased morbidity for patients compared with traditional open operations [14,15]. The combination of EFTRs with laparoscopic surgery for colonic lesions is therefore a logical next step. Some colonic polyps or tumors may be more difficult to resect using endoscopic methods alone, especially those that are large and sessile. As in other situations, laparoscopy offers the ability to manipulate the colon, mobilize difficult-to-access areas, and provide definitive closure after fullthickness resection, whereas endoscopy allows for accurate visualization of margins while performing resection and the removal of minimal healthy surrounding tissue. Fukunaga et al [16] recently described the use of cooperative surgery for the specific case of patients with laterally spreading colorectal tumors that were not amenable to endoscopic resection alone. They described a method similar to that used in other areas of the body, with laparoscopy used to help locate the lesion, complete the full-thickness dissection, and finally to close the enterotomy with a linear stapling device. This approach is similar to that described by several authors, and takes advantage of endoscopic localization and resection while allowing for a definitive closure after full-thickness resection or inadvertent perforation [6,17,18]. It may spare patients the morbidity of a hemicolectomy for benign disease processes, and the use of endoscopic resection may reduce the risk of stricture caused by the use of a linear stapler device. Fukunaga reported a series of 3 patients who underwent a cooperative resection for laterally spreading colorectal tumors. All patients were resected with adequate margins. Mean operating time was 205 minutes, estimated blood loss 13 cc, and there were no intraoperative or postoperative complications. Follow-up endoscopy at 1 year showed no evidence of luminal stenosis or local recurrence [16]. Other authors have examined the role of laparoscopic assistance in partial-thickness endoscopic resections and polypectomy; however, more data are needed to evaluate the role of laparoscopy in planned full-thickness colonoscopic resections.
6. Conclusions Laparoscopic-assisted EFTR is an emerging method for the minimally invasive treatment of benign and early invasive GI tumors that are otherwise difficult to approach. Based on early case reports and small series using this approach, it seems to be a safe and effective strategy when applied properly. Although promising, further research is necessary to determine the best
114
I.W. Folkert, R.E. Roses / Techniques in Gastrointestinal Endoscopy 17 (2015) 112–114
indications for such an approach, and to compare long-term outcomes to those achieved with more traditional approaches. References [1] Schubert D, Kuhn R, Nestler G, Kahl S, Ebert MP, Malfertheiner P, et al. Laparoscopic-endoscopic rendezvous resection of upper gastrointestinal tumors. Dig Dis 2005;23:106–12 [PubMed PMID: 16352889]. [2] Hiki N, Nunobe S, Matsuda T, Hirasawa T, Yamamoto Y, Yamaguchi T. Laparoscopic endoscopic cooperative surgery. Dig Endosc 2015;27:197–204 [PubMed PMID: 25394216]. [3] Tsushimi T, Mori H, Harada T, Nagase T, Iked Y, Ohnishi H. Laparoscopic and endoscopic cooperative surgery for duodenal neuroendocrine tumor (NET) G1: report of a case. Int J Surg Case Rep 2014;5:1021–4 [PubMed PMID: 25460463. Pubmed Central PMCID: 4275848]. [4] Tsujimoto H, Ichikura T, Nagao S, Sato T, Ono S, Aiko S, et al. Minimally invasive surgery for resection of duodenal carcinoid tumors: endoscopic full-thickness resection under laparoscopic observation. Surg Endosc 2010; 24:471–5 [PubMed PMID: 19517164]. [5] Abe N, Takeuchi H, Yanagida O, Masaki T, Mori T, Sugiyama M, et al. Endoscopic full-thickness resection with laparoscopic assistance as hybrid NOTES for gastric submucosal tumor. Surg Endosc 2009;23:1908–13 [PubMed PMID: 19184206]. [6] Feussner H, Wilhelm D, Dotzel V, Papagoras D, Frimberger E. Combined endoluminal and endocavitary approaches to colonic lesions. Surg Technol Int 2003;11:97–101 [PubMed PMID: 12931289]. [7] Ohgami M, Otani Y, Kumai K, Kubota T, Kim YI, Kitajima M. Curative laparoscopic surgery for early gastric cancer: five years experience. World J Surg 1999;23:187–92 [discussion 92-3. PubMed PMID: 9880430]. [8] Seto Y, Yamaguchi H, Shimoyama S, Shimizu N, Aoki F, Kaminishi M. Results of local resection with regional lymphadenectomy for early gastric cancer. Am J Surg 2001;182:498–501 [PubMed PMID: 11754858]. [9] Hiki N, Yamamoto Y, Fukunaga T, Yamaguchi T, Nunobe S, Tokunaga M, et al. Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection. Surg Endosc 2008;22:1729–35 [PubMed PMID: 18074180].
[10] Tsujimoto H, Yaguchi Y, Kumano I, Takahata R, Ono S, Hase K. Successful gastric submucosal tumor resection using laparoscopic and endoscopic cooperative surgery. World J Surg 2012;36:327–30 [PubMed PMID: 22187132]. [11] Sato T, Fukunaga T, Ohyama S, Ueno M, Oya M, Yamamoto J, et al. Endoscopic total layer resection with laparoscopic sentinel node dissection and defect closure for duodenal carcinoid. Hepatogastroenterology 2005;52:678–9 [PubMed PMID: 15966180]. [12] Abe N, Takeuchi H, Shibuya M, Ohki A, Yanagida O, Masaki T, et al. Successful treatment of duodenal carcinoid tumor by laparoscopy-assisted endoscopic full-thickness resection with lymphadenectomy. Asian J Endosc Surg 2012;5:81–5 [PubMed PMID: 22776369]. [13] Sakon M, Takata M, Seki H, Hayashi K, Munakata Y, Tateiwa N. A novel combined laparoscopic-endoscopic cooperative approach for duodenal lesions. J Laparoendosc Adv Surg Tech A 2010;20:555–8 [PubMed PMID: 20578925]. [14] Clinical Outcomes of Surgical Therapy Study G. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004;350:2050–9 [PubMed PMID: 15141043]. [15] Bartels SA, Gardenbroek TJ, Ubbink DT, Buskens CJ, Tanis PJ, Bemelman WA. Systematic review and meta-analysis of laparoscopic versus open colectomy with end ileostomy for non-toxic colitis. Br J Surg 2013;100:726–33 [PubMed PMID: 23355043]. [16] Fukunaga Y, Tamegai Y, Chino A, Ueno M, Nagayama S, Fujimoto Y, et al. New technique of en bloc resection of colorectal tumor using laparoscopy and endoscopy cooperatively (laparoscopy and endoscopy cooperative surgery—colorectal). Dis Colon Rectum 2014;57:267–71 [PubMed PMID: 24401891]. [17] Yan J, Trencheva K, Lee SW, Sonoda T, Shukla P, Milsom JW. Treatment for right colon polyps not removable using standard colonoscopy: combined laparoscopic-colonoscopic approach. Dis Colon Rectum 2011;54:753–8 [PubMed PMID: 21552062]. [18] Wilhelm D, von Delius S, Weber L, Meining A, Schneider A, Friess H, et al. Combined laparoscopic-endoscopic resections of colorectal polyps: 10-year experience and follow-up. Surg Endosc 2009;23:688–93 [PubMed PMID: 19169747].
Contents lists available at ScienceDirect
Techniques in Gastrointestinal Endoscopy journal homepage: www.techgiendoscopy.com/locate/tgie
Endoscopic full-thickness resection with laparoscopic assistance Ian W. Folkert, MDn, Robert E. Roses, MD Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, Pennsylvania 19104
a r t i c l e in f o
abstract
Article history: Received 6 April 2015 Accepted 20 June 2015
Endoscopic full-thickness resection of gastrointestinal (GI) tumors has been applied to the management of premalignant, early malignant, and indolent tumors of the GI tract to spare morbidity associated with traditional surgical approaches. Increasingly, a combined laparoscopic-endoscopic approach is being used to treat lesions that are not amenable to endoscopic resection alone. Case reports and small case series have demonstrated utility for lesions such as gastric GI stromal tumors, early gastric carcinomas, small duodenal masses, and colonic polyps or masses. Although promising, further research is necessary to determine the best indications for such an approach, and to compare long-term outcomes to those achieved with more traditional approaches. & 2015 Elsevier Inc. All rights reserved.
Keywords: Endoscopy Laparoscopy Minimally invasive Rendezvous surgery Laparoendoscopic
1. Introduction Endoscopic full-thickness resection (EFTR) of gastrointestinal tumors has been applied to the management of premalignant, early malignant, and indolent tumors of the gastrointestinal (GI) tract to spare morbidity associated with traditional surgical approaches. Similarly, laparoscopic approaches to GI surgery may limit morbidity associated with open surgical approaches. The last decade has witnessed broader application of such approaches. In some instances, however, laparoscopic or endoscopic approaches are not sufficient. A limitation of laparoscopy is the inability to visualize the luminal surface of the GI tract. For example, in the case of endophytic gastric or colonic tumors, accurately locating the lesion without endoscopic assistance may not be possible. Tumors at or near the gastroesophageal junction can also be challenging to resect without compromising the patency of the gastroesophageal junction. Application of full-thickness endoscopic resection, on the contrary, may be limited by poor visualization, or a prohibitive risk of perforation owing to the technical challenges of closure after resection. The limitations of laparoscopy or endoscopy alone have led to the emergence of a combined, so-called laparoendoscopic, cooperative, or rendezvous approach to resection [1,2]. Examples of tumors that may be amenable to a combined endoscopiclaparoscopic approach include gastric GI stromal tumors, early gastric carcinomas, small duodenal masses, and colonic polyps or
The author reports no direct financial interests that might pose a conflict of interest in connection with the submitted manuscript. n Corresponding author. E-mail address: [email protected] (I.W. Folkert). http://dx.doi.org/10.1016/j.tgie.2015.06.004 0049-0172/& 2015 Elsevier Inc. All rights reserved.
masses. Laparoscopy-assisted EFTR has been described for gastric, duodenal, and colonic tumors [3-6]. This review discusses indications, techniques, and outcomes for EFTR of GI tumors with laparoscopic assistance.
2. Techniques In many cases, laparoscopy can be used to surgically close a defect after full-thickness endoscopic resection, especially in difficult anatomical locations with limited intraluminal working space [3,4]. It also allows for mobilization of structures and observation for unintentional perforation or injury to surrounding structures during full-thickness resection. Access is gained to the peritoneal cavity using either an open (Hasson) technique or a Veress needle. Carbon dioxide is used to create pneumoperitoneum, allowing for visualization of intra-abdominal organs as well as safe subsequent port placement. Placement of working ports depends on the location of the lesion and patient body habitus.
3. Gastric lesions Gastric GI stromal tumors, benign, and early malignant tumors of the stomach are increasingly treated with either laparoscopic wedge resection or endoscopic resections. Laparoscopic wedge resections may spare the patient the morbidity of a subtotal or total gastrectomy, while still allowing for resection with negative margins [7,8]. However, some lesions may be anatomically difficult to resect laparoscopically using a linear stapler, making endoscopic resection with laparoscopic assistance a suitable alternative.
I.W. Folkert, R.E. Roses / Techniques in Gastrointestinal Endoscopy 17 (2015) 112–114
A cooperative approach is also particularly helpful for endophytic tumors, which can be difficult to locate using a laparoscopic approach alone. Several authors have described a combined approach to gastric lesions wherein the endoscope is used to dissect circumferentially around the tumor or mass in a submucosal layer. Then, laparoscopy is used to dissect the seromuscular layer three-fourths of the circumference around the mass along the line of endoscopic dissection. After this dissection the tumor is flipped into the abdominal cavity using laparoscopic graspers, and dissected free with simultaneous closure of the gastric wall defect using a laparoscopic stapling device [9,10]. This allows for precise control of the margin around the mass. A variation of this approach is to perform most of the full-thickness seromuscular dissection endoscopically, complete the resection using laparoscopy, and finally to hand-sew the gastric defect closed laparoscopically [5]. Hiki et al reported a series of 7 patients undergoing a combined approach for gastric submucosal tumors using the aforementioned techniques. All 7 patients had uneventful postoperative courses, with successful resection of the tumor in all cases, a mean operating time of 169 minutes, and an average estimated blood loss of 7 cc [9]. Tsujimoto also reported on a series of 20 patients undergoing similar resection of gastric submucosal tumors. All patients in that series underwent successful resection, with minimal blood loss, and no postoperative morbidity or mortality [10]. In a series of 4 patients who had hand-sewn laparoscopic closure performed after endoscopic resection, Abe et al [5] reported no intraoperative or postoperative adverse events and no evidence of leak or abnormal gastric motility on postoperative upper GI.
4. Duodenal Benign and small lesions of the duodenum can be difficult to treat via a minimally invasive approach. Small lesions within the duodenum can be difficult to localize, and the fixed retroperitoneal location of the duodenum allows limited working room for the endoscopist. The thin-walled nature of the duodenum may predispose to inadvertent perforation or injury during endoscopic resection. Laparoscopic assistance allows for mobilization of the duodenum, monitoring for inadvertent injury to surrounding structures during full-thickness resection, and for closure of defects in the duodenal wall created during endoscopic resection. Cooperative surgery for such duodenal lesions may potentially spare patients with benign or indolent disease processes the morbidity of a duodenal or pancreaticoduodenal resection. Tsujimoto et al [4] described a technique using a cap-fitted endoscope to perform full-thickness resection of duodenal carcinoid tumors, with laparoscopic assistance for duodenal mobilization and subsequent closure. As the authors discuss, a combined approach to the resection of such duodenal lesions has several benefits. Laparoscopic resection with a linear stapler device can potentially narrow the lumen of the duodenum, whereas endoscopic resection alone is associated with a risk of suction injury to surrounding structures or inadequate closure of the lumen. The approach described by Tsujimoto involves initial laparoscopic mobilization of the duodenum, followed by endoscopic suction and resection of the lesion under laparoscopic visualization. Laparoscopic hand suturing then closes the defect. Sato described a similar strategy for duodenal carcinoid tumors, employing EFTR under laparoscopic visualization, followed by laparoscopic sentinel lymph node dissection and closure of the duodenal defect [11]. Other case reports describe similar methodology, in some cases using laparoscopy to perform lymph node biopsy at the time of endoscopic resection [12,13].
113
Tsujimoto et al reported a series of 2 patients undergoing cooperative resection for duodenal carcinoid tumor using the techniques described earlier. Both patients were successfully resected, with a mean operating time of 116 minutes, minimal blood loss, and uneventful postoperative courses [4]. Sakon et al also reported a series of 2 patients undergoing combined laparoscopic-endoscopic resection of duodenal lesions. Both patients underwent successful resection of a tubular adenoma, with adequate margins, minimal blood loss, and no postoperative complications [13]. Other single-patient case reports also demonstrate adequate resection and minimal postoperative morbidity with such an approach [3,12].
5. Colonic lesions Endoscopists have been pushing the boundaries of endoscopic resection of colon polyps and masses for many years. Similarly, laparoscopic colon resections are increasingly common, and may lead to faster recovery time and decreased morbidity for patients compared with traditional open operations [14,15]. The combination of EFTRs with laparoscopic surgery for colonic lesions is therefore a logical next step. Some colonic polyps or tumors may be more difficult to resect using endoscopic methods alone, especially those that are large and sessile. As in other situations, laparoscopy offers the ability to manipulate the colon, mobilize difficult-to-access areas, and provide definitive closure after fullthickness resection, whereas endoscopy allows for accurate visualization of margins while performing resection and the removal of minimal healthy surrounding tissue. Fukunaga et al [16] recently described the use of cooperative surgery for the specific case of patients with laterally spreading colorectal tumors that were not amenable to endoscopic resection alone. They described a method similar to that used in other areas of the body, with laparoscopy used to help locate the lesion, complete the full-thickness dissection, and finally to close the enterotomy with a linear stapling device. This approach is similar to that described by several authors, and takes advantage of endoscopic localization and resection while allowing for a definitive closure after full-thickness resection or inadvertent perforation [6,17,18]. It may spare patients the morbidity of a hemicolectomy for benign disease processes, and the use of endoscopic resection may reduce the risk of stricture caused by the use of a linear stapler device. Fukunaga reported a series of 3 patients who underwent a cooperative resection for laterally spreading colorectal tumors. All patients were resected with adequate margins. Mean operating time was 205 minutes, estimated blood loss 13 cc, and there were no intraoperative or postoperative complications. Follow-up endoscopy at 1 year showed no evidence of luminal stenosis or local recurrence [16]. Other authors have examined the role of laparoscopic assistance in partial-thickness endoscopic resections and polypectomy; however, more data are needed to evaluate the role of laparoscopy in planned full-thickness colonoscopic resections.
6. Conclusions Laparoscopic-assisted EFTR is an emerging method for the minimally invasive treatment of benign and early invasive GI tumors that are otherwise difficult to approach. Based on early case reports and small series using this approach, it seems to be a safe and effective strategy when applied properly. Although promising, further research is necessary to determine the best
114
I.W. Folkert, R.E. Roses / Techniques in Gastrointestinal Endoscopy 17 (2015) 112–114
indications for such an approach, and to compare long-term outcomes to those achieved with more traditional approaches. References [1] Schubert D, Kuhn R, Nestler G, Kahl S, Ebert MP, Malfertheiner P, et al. Laparoscopic-endoscopic rendezvous resection of upper gastrointestinal tumors. Dig Dis 2005;23:106–12 [PubMed PMID: 16352889]. [2] Hiki N, Nunobe S, Matsuda T, Hirasawa T, Yamamoto Y, Yamaguchi T. Laparoscopic endoscopic cooperative surgery. Dig Endosc 2015;27:197–204 [PubMed PMID: 25394216]. [3] Tsushimi T, Mori H, Harada T, Nagase T, Iked Y, Ohnishi H. Laparoscopic and endoscopic cooperative surgery for duodenal neuroendocrine tumor (NET) G1: report of a case. Int J Surg Case Rep 2014;5:1021–4 [PubMed PMID: 25460463. Pubmed Central PMCID: 4275848]. [4] Tsujimoto H, Ichikura T, Nagao S, Sato T, Ono S, Aiko S, et al. Minimally invasive surgery for resection of duodenal carcinoid tumors: endoscopic full-thickness resection under laparoscopic observation. Surg Endosc 2010; 24:471–5 [PubMed PMID: 19517164]. [5] Abe N, Takeuchi H, Yanagida O, Masaki T, Mori T, Sugiyama M, et al. Endoscopic full-thickness resection with laparoscopic assistance as hybrid NOTES for gastric submucosal tumor. Surg Endosc 2009;23:1908–13 [PubMed PMID: 19184206]. [6] Feussner H, Wilhelm D, Dotzel V, Papagoras D, Frimberger E. Combined endoluminal and endocavitary approaches to colonic lesions. Surg Technol Int 2003;11:97–101 [PubMed PMID: 12931289]. [7] Ohgami M, Otani Y, Kumai K, Kubota T, Kim YI, Kitajima M. Curative laparoscopic surgery for early gastric cancer: five years experience. World J Surg 1999;23:187–92 [discussion 92-3. PubMed PMID: 9880430]. [8] Seto Y, Yamaguchi H, Shimoyama S, Shimizu N, Aoki F, Kaminishi M. Results of local resection with regional lymphadenectomy for early gastric cancer. Am J Surg 2001;182:498–501 [PubMed PMID: 11754858]. [9] Hiki N, Yamamoto Y, Fukunaga T, Yamaguchi T, Nunobe S, Tokunaga M, et al. Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection. Surg Endosc 2008;22:1729–35 [PubMed PMID: 18074180].
[10] Tsujimoto H, Yaguchi Y, Kumano I, Takahata R, Ono S, Hase K. Successful gastric submucosal tumor resection using laparoscopic and endoscopic cooperative surgery. World J Surg 2012;36:327–30 [PubMed PMID: 22187132]. [11] Sato T, Fukunaga T, Ohyama S, Ueno M, Oya M, Yamamoto J, et al. Endoscopic total layer resection with laparoscopic sentinel node dissection and defect closure for duodenal carcinoid. Hepatogastroenterology 2005;52:678–9 [PubMed PMID: 15966180]. [12] Abe N, Takeuchi H, Shibuya M, Ohki A, Yanagida O, Masaki T, et al. Successful treatment of duodenal carcinoid tumor by laparoscopy-assisted endoscopic full-thickness resection with lymphadenectomy. Asian J Endosc Surg 2012;5:81–5 [PubMed PMID: 22776369]. [13] Sakon M, Takata M, Seki H, Hayashi K, Munakata Y, Tateiwa N. A novel combined laparoscopic-endoscopic cooperative approach for duodenal lesions. J Laparoendosc Adv Surg Tech A 2010;20:555–8 [PubMed PMID: 20578925]. [14] Clinical Outcomes of Surgical Therapy Study G. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004;350:2050–9 [PubMed PMID: 15141043]. [15] Bartels SA, Gardenbroek TJ, Ubbink DT, Buskens CJ, Tanis PJ, Bemelman WA. Systematic review and meta-analysis of laparoscopic versus open colectomy with end ileostomy for non-toxic colitis. Br J Surg 2013;100:726–33 [PubMed PMID: 23355043]. [16] Fukunaga Y, Tamegai Y, Chino A, Ueno M, Nagayama S, Fujimoto Y, et al. New technique of en bloc resection of colorectal tumor using laparoscopy and endoscopy cooperatively (laparoscopy and endoscopy cooperative surgery—colorectal). Dis Colon Rectum 2014;57:267–71 [PubMed PMID: 24401891]. [17] Yan J, Trencheva K, Lee SW, Sonoda T, Shukla P, Milsom JW. Treatment for right colon polyps not removable using standard colonoscopy: combined laparoscopic-colonoscopic approach. Dis Colon Rectum 2011;54:753–8 [PubMed PMID: 21552062]. [18] Wilhelm D, von Delius S, Weber L, Meining A, Schneider A, Friess H, et al. Combined laparoscopic-endoscopic resections of colorectal polyps: 10-year experience and follow-up. Surg Endosc 2009;23:688–93 [PubMed PMID: 19169747].