Total Laparoskopik Mide Cerrahisinde İntraoperatif Gastroskopinin Lezyon Lokalizasyonundaki Etkinliği

GİRİŞ ve AMAÇ: Mide kanserinin total laparoskopik cerrahisinde, transeksiyon hattını belirlemek zor olabilir. Bu retrospektif çalışma, total laparoskopik gastrektomide rezeksiyon marjını belirlemede intraoperatif gastroskopinin klinik önemini değerlendirmeyi amaçlamaktadır. YÖNTEM ve GEREÇLER: Mart 2017 ve Ocak 2021 tarihleri arasında total laparoskopik gastrektomi sırasında rezeksiyon sınırını belirlemek için intraoperatif gastroskopi yapılan 55 hasta çalışmaya dahil edildi. Endoskopik görüntülemede lezyon yerleşimi tespit edildikten sonar ışık transillüminasyonu ile rezeksiyon sınırı belirlenerek transeksiyon yapıldı. BULGULAR: İntraoperatif gastroskopiile total laparoskopik gastrektomi uygulanan 55 hastanın 28’ i(%50.9) erkek, 27’ si (%49.1) kadın ve yaş ortalaması 59.89±11.18 idi. Tümör yerleşimi, 25 (%45.4) hastada proksimal 1/3, 9 (% 16.4) hastada orta 1/3 ve 21 (%38.2) hastada ise distal 1/3 yerleşimliydi. İntraoperatif gastroskopi yapılan ve total laparoskopik tamamlanan 19 (%34.5) hastaya subtotal gastrektomi, 10 (%18.2) hastaya vertical gastrektomi ve 26 (%47.3) hastaya total gastrektomi uygulandı. Hastalarda intraoperatif gastroskopiye bağlı komplikasyon görülmedi. Tüm olguların rezeksiyon marjının güvenli sınırlarda olduğu histopatolojik analiz ile gösterildi. TARTIŞMA ve SONUÇ: Total laparoskopik gastrektomide, tümör lokalizasyonunu belirlemek ve rezeksiyon sınır güvenliğini sağlamak amacıyla intraoperatif gastroskopi güvenilir bir prosedürdür.

Efficiency of Intraoperative Gastroscopy in Lesion Localization in Totally Laparoscopic Gastric Surgery

INTRODUCTION: It can be difficult to determine the transection line in total laparoscopic surgery of gastric cancer. This retrospective study aims to evaluate the clinical significance of intraoperative gastroscopy in determining the resection margin in total laparoscopic gastrectomy. METHODS: 55 patients who underwent intraoperative gastroscopy to determine the resection margin during total laparoscopic gastrectomy between March 2017 and January 2021 were included in the study. After the lesion location was determined in endoscopic imaging, transection was performed by determining the resection margin with light transillumination. RESULTS: Of 55 patients who underwent total laparoscopic gastrectomy with intraoperative gastroscopy, 28 (50.9%) were male, 27 (49.1%) were female, and the mean age was 59.89±11.18 years. Tumor was located in 1/3 proximal in 25 patients (45.4%), 1/3 medial in 9 patients (16.4%) and 1/3 distal in 21 patients (38.2%). Of the patients who underwent intraoperative gastroscopy and completed total laparoscopic surgery, subtotal gastrectomy was performed in 19 (34.5%) patients, vertical gastrectomy was performed in 10 (18.2%) patients, and total gastrectomy was performed in 26 (47.3%) patients. No complications related to intraoperative gastroscopy were observed in the patients. Resection margins of all cases were shown to be within safe limits by histopathological analysis. DISCUSSION AND CONCLUSION: Intraoperative gastroscopy is a reliable procedure in total laparoscopic gastrectomy in tumor localization and to ensure resection margin safety.

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