Application of` the variable angle traction method by using clip with dental in super minimally invasive non full thickness resection of early gastric cancer
10.3760/cma.j.cn115455-20230809-00100
- VernacularTitle:胃早癌超级微创非全层切除术中组织夹-牙线可变角度牵引法的应用
- Author:
Qun SHAO
1
;
Xiangdong WANG
;
Ke HAN
;
Jinping LI
;
Zhaobei CAI
;
Enqiang LINGHU
;
Qianqian CHEN
Author Information
1. 解放军总医院第一医学中心消化内科医学部消化内镜超级微创科，北京 100853
- Keywords:
Stomach neoplasms;
Super minimally invasive surgery;
Partial excision;
Assisted traction technology;
Submucosal dissection
- From:
Chinese Journal of Postgraduates of Medicine
2024;47(3):221-225
- CountryChina
- Language:Chinese
-
Abstract:
Objective:Assisted traction technology is effective in increasing the rate of super minimally invasive surgery (SMIS) in patients with early gastric cancer (EGC), and shortening the operator′s learning curve. We adopt the variable angle traction technique of tissue clamp dental floss as a traction technique in this research.Methods:Patients with early gastric cancer who were treated with SMIS - non full layer resection of EGC were enrolled in the First Medical Center of Chinese PLA General Hospital from January 2022 to June 2023. This research was carried out by experts at the same level. It was divided into two groups: traction and non-traction. Submucosal detachment time (SDT), submucosal detachment rate (SDS), lamina propria exposure, muscularis propria defect (MPD), bleeding during operation, block resection, surgical resection, hand operation expenses, and surgical instruments were recorded.Results:Nine patients adopted variable angle traction, and 9 patients did not. The overall resection rate and curative resection rate of both groups were 100%. The mean SDT time was 28.00 (21.00, 34.00) min in traction group and 56.00 (40.00, 85.00) min in non traction group. And it had statistical significance ( P = 0.005). The SDS was (0.58 ± 0.21) cm 2/min in traction group and (0.23 ± 0.10) cm 2/min in non-traction group. And it had statistical significance ( P<0.05). Exposure of intrinsic muscle layer (IML): 8 cases in the traction group and 6 cases in the non-traction group. Intraoperative IML injury: in the traction group, 8 cases were MPD-0 and 1 case was MPD-Ft; in the non-traction group, 4 cases were MPD-0, 1 case was MPD-Pt, and 4 cases were MPD-Ft. There was no statistical difference between the two groups in terms of intraoperative bleeding, hospitalization expenses, surgical expenses, and the total hospitalization time. There were no serious adverse reactions or outcomes. Conclusions:The variable angle traction method accelerates SDT and SDS for SMIS-non full layer resection of EGC. It has the advantages of the sufficient separation of IML and mucosal layer, the deeper dissection depth, the low injury of IML, low intraoperative bleeding, and no additional medical costs. Therefore, this method can become an auxiliary treatment technology for SMIS.
