Department of Surgery, Institute of Digestive Disease, CUHK Jockey Club Minimally Invasive Surgical Skills Center, The Chinese University of Hong Kong, Hong Kong S.A.R, China,
Surg Endosc. 2014 Jan;28(1):319-24. doi: 10.1007/s00464-013-3149-3. Epub 2013 Aug 29.
Gastric submucosal tumors are often treated by laparoscopic wedge resection. This study aimed to examine the feasibility of gastric full-thickness resection through a totally endoscopic approach using the master and slave transluminal endoscopic robot (MASTER), and closure of the luminal defect with an endoscopic suturing device.
The operation was performed in two live porcine models under general anesthesia. First, the anterior wall of the stomach was slung to the abdominal wall using a percutaneous suturing device. An imaginary 5-cm lesion was marked using a needle knife. After the initial mucosal incision was made using an IT knife, the MASTER was introduced through a long overtube. A circumferential mucosal incision was completed with the MASTER to expose the muscularis propria which was grasped and incised to the serosal layer by electrocautery applied through the hook of the MASTER. The full-thickness resection of the gastric wall was completed with retraction using the grasper and dissection using the hook. While the defect was being created, the luminal space was maintained with traction of the percutaneous sutures. The defect was closed with suture plication using an Apollo Overstitch device.
Two full-thickness gastric resections were performed in two nonsurvival porcine models (body weight = 30 and 35 kg, respectively) using the MASTER. The total procedure time was 56 min for the first model and 70 min for the second model. The luminal view was maintained during the whole procedure, and there was no damage to surrounding organs throughout the whole procedure. The gastric defects were closed successfully using Overstitch, with satisfactory gastric distension and no gas leakage afterward.
The current experiment demonstrated the feasibility and safety of a totally endoscopic approach for the treatment of gastric submucosal tumors: full-thickness resection with the MASTER and successful closure of the defect using Overstitch.
胃黏膜下肿瘤常采用腹腔镜楔形切除术进行治疗。本研究旨在探讨通过使用主从式经腔内镜机器人（MASTER）经完全内镜途径进行胃全层切除术的可行性，并使用内镜缝合装置闭合管腔缺损。
在全身麻醉下，对两只活猪模型进行了手术。首先，使用经皮缝合装置将胃前壁悬挂到腹壁上。使用针刀标记一个想象中的 5cm 病变。在使用 IT 刀进行初步黏膜切开后，将 MASTER 通过长外套管引入。使用 MASTER 完成环形黏膜切开，暴露固有肌层，通过 MASTER 的钩部施加电烙切除固有肌层到达浆膜层。使用抓钳进行全层胃壁牵拉，使用钩部进行解剖，完成全层胃壁切除。在创建缺损的同时，通过经皮缝线的牵引维持管腔空间。使用 Apollo Overstitch 装置进行缝合折叠来闭合缺损。
使用 MASTER 在两只非存活猪模型（体重分别为 30kg 和 35kg）中完成了两次全层胃切除术。第一个模型的总手术时间为 56 分钟，第二个模型为 70 分钟。整个手术过程中保持了管腔视野，整个手术过程中没有对周围器官造成损伤。使用 Overstitch 成功闭合了胃缺损，胃充盈良好，之后没有气体泄漏。
本实验证明了使用 MASTER 进行全层胃切除术和使用 Overstitch 成功闭合缺损的完全内镜方法的可行性和安全性，用于治疗胃黏膜下肿瘤。
