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Seong-Ho KONG

Seoul National University Cancer Research Institute
Seoul, South Korea
MD
588 likes
12.7K views
2 comments
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Laparoscopic total gastrectomy guided by fluorescent lymphangiography using ICG injection around a tumor, followed by an intracorporeal double stapling esophagojejunostomy
Injecting indocyanine green (ICG) around the tumor enables the operators to identify the lymphatic channels and the lymph nodes in which the cancer cells can spread. It also allows them to decide on the extent of the dissection and validate the completeness of lymph node dissection. In this video, a laparoscopic near-infrared fluorescent camera was used, showing the fluorescent signal in diverse modes. A total gastrectomy with D1+ dissection is performed. The fluorescent signal shows the possible lymphatic pathways during the operation. An intracorporeal esophagojejunostomy was performed in a double stapling fashion; a round needle and a surgical thread are attached to the plastic part of the anvil of the circular stapler.
HK Yang, SH Kong
Surgical intervention
2 years ago
1645 views
74 likes
0 comments
15:56
Laparoscopic total gastrectomy guided by fluorescent lymphangiography using ICG injection around a tumor, followed by an intracorporeal double stapling esophagojejunostomy
Injecting indocyanine green (ICG) around the tumor enables the operators to identify the lymphatic channels and the lymph nodes in which the cancer cells can spread. It also allows them to decide on the extent of the dissection and validate the completeness of lymph node dissection. In this video, a laparoscopic near-infrared fluorescent camera was used, showing the fluorescent signal in diverse modes. A total gastrectomy with D1+ dissection is performed. The fluorescent signal shows the possible lymphatic pathways during the operation. An intracorporeal esophagojejunostomy was performed in a double stapling fashion; a round needle and a surgical thread are attached to the plastic part of the anvil of the circular stapler.
Gastric GIST: minimally invasive surgical modalities
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor, and the stomach is the most frequent location (50-60%). Gastric GIST presents as a submucosal tumor and is often found incidentally. Submucosal tumors greater than 2cm are indicated for resection. Indication for laparoscopic surgery is not strictly determined by the size, but whether surgery can follow resection principles, 1) R0 resection with histologically negative margins, 2) all efforts are made to prevent tumor rupture. Wedge resection using a linear stapler, also called “exogastric resection” is effective in most cases. However, the operator should pay attention to align the direction of the linear stapler “transversely” to the long axis of the stomach, otherwise it can cause gastric lumen narrowing after resection, especially in case of a relatively large tumor with endophytical growth. Endoscopy is very useful to identify and define tumor resection margins for endophytic tumor, and the “eversion” technique is one option to reduce the amount of normal mucosa resection. GIST cases located at the posterior wall of the upper stomach are technically challenging, and transgastric or intragastric techniques are suggested as good surgical options for such tumors. Laparoscopic or endoscopic “coring out” techniques can be dangerous, because of the high risk of tumor rupture and gastric wall perforation, which can cause peritoneal seeding when both take place simultaneously.
SH Kong
Lecture
3 years ago
2024 views
116 likes
0 comments
22:10
Gastric GIST: minimally invasive surgical modalities
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor, and the stomach is the most frequent location (50-60%). Gastric GIST presents as a submucosal tumor and is often found incidentally. Submucosal tumors greater than 2cm are indicated for resection. Indication for laparoscopic surgery is not strictly determined by the size, but whether surgery can follow resection principles, 1) R0 resection with histologically negative margins, 2) all efforts are made to prevent tumor rupture. Wedge resection using a linear stapler, also called “exogastric resection” is effective in most cases. However, the operator should pay attention to align the direction of the linear stapler “transversely” to the long axis of the stomach, otherwise it can cause gastric lumen narrowing after resection, especially in case of a relatively large tumor with endophytical growth. Endoscopy is very useful to identify and define tumor resection margins for endophytic tumor, and the “eversion” technique is one option to reduce the amount of normal mucosa resection. GIST cases located at the posterior wall of the upper stomach are technically challenging, and transgastric or intragastric techniques are suggested as good surgical options for such tumors. Laparoscopic or endoscopic “coring out” techniques can be dangerous, because of the high risk of tumor rupture and gastric wall perforation, which can cause peritoneal seeding when both take place simultaneously.
Robotic distal gastrectomy with the EndoWrist® One Vessel Sealer
The EndoWrist® One vessel sealer is a wristed, single-use instrument of the da Vinci surgical robotic system intended for bipolar coagulation and mechanical transection of vessels up to 7mm in diameter and tissue bundles. It could be a potential instrument to overcome the limitation of straight energy-based devices. Although it has the advantage of having an endowrist function which allows easy access to the surgical planes in ideal directions, it requires special caution and know-how to use the device safely and effectively, because of a relatively blunt tip and the absence of an active blade at the tip.
This video of the robotic distal gastrectomy for early gastric cancer shows how to harmonize the use of a sharp instrument with conventional bipolar electricity and of the vessel sealer device to maximize the advantages of such devices and to ensure safety. A conventional bipolar forceps is used to make entrance holes on the tissue for a safe application of the vessel sealer, and to perform fine dissections of small tissues, which are difficult to manage using a vessel sealer. Once the access hole has been made, the vessel sealer is applied in an ideal axis to the avascular tissue plane, thanks to the free wrist function. This technique combined with a sharp instrument using conventional bipolar electricity seems to be helpful for a safe and effective operation, which can use the benefit of the vessel sealer to its full potential, for instance with a high degree of freedom of the movement and secure sealing of lymphovascular structures.
HK Yang, SH Kong
Surgical intervention
3 years ago
1361 views
81 likes
0 comments
10:38
Robotic distal gastrectomy with the EndoWrist® One Vessel Sealer
The EndoWrist® One vessel sealer is a wristed, single-use instrument of the da Vinci surgical robotic system intended for bipolar coagulation and mechanical transection of vessels up to 7mm in diameter and tissue bundles. It could be a potential instrument to overcome the limitation of straight energy-based devices. Although it has the advantage of having an endowrist function which allows easy access to the surgical planes in ideal directions, it requires special caution and know-how to use the device safely and effectively, because of a relatively blunt tip and the absence of an active blade at the tip.
This video of the robotic distal gastrectomy for early gastric cancer shows how to harmonize the use of a sharp instrument with conventional bipolar electricity and of the vessel sealer device to maximize the advantages of such devices and to ensure safety. A conventional bipolar forceps is used to make entrance holes on the tissue for a safe application of the vessel sealer, and to perform fine dissections of small tissues, which are difficult to manage using a vessel sealer. Once the access hole has been made, the vessel sealer is applied in an ideal axis to the avascular tissue plane, thanks to the free wrist function. This technique combined with a sharp instrument using conventional bipolar electricity seems to be helpful for a safe and effective operation, which can use the benefit of the vessel sealer to its full potential, for instance with a high degree of freedom of the movement and secure sealing of lymphovascular structures.
Laparoscopic wedge resection of gastric gastrointestinal stromal tumor (GIST) with linear staplers in a transverse direction
This video presents a case of laparoscopic wedge resection for a gastric gastrointestinal stromal tumor (GIST). Exogastric resection using a stapler is effective for most GIST cases. However, there is a risk of gastric lumen narrowing after stapling in case of endophytically growing tumor unless the direction of the stapler is aligned transversely, which means in a perpendicular direction to the long axis of the stomach. This video shows how to access the tumor located at the posterior wall of the stomach, usefulness of the intraoperative endoscopy to identify the location of the tumor, and the presence of intraluminal bleeding from the staple line, and how to apply the linear stapler in a transverse direction in a laparoscopic wedge resection for gastric GIST.
HK Yang, SH Kong
Surgical intervention
3 years ago
2053 views
116 likes
0 comments
03:36
Laparoscopic wedge resection of gastric gastrointestinal stromal tumor (GIST) with linear staplers in a transverse direction
This video presents a case of laparoscopic wedge resection for a gastric gastrointestinal stromal tumor (GIST). Exogastric resection using a stapler is effective for most GIST cases. However, there is a risk of gastric lumen narrowing after stapling in case of endophytically growing tumor unless the direction of the stapler is aligned transversely, which means in a perpendicular direction to the long axis of the stomach. This video shows how to access the tumor located at the posterior wall of the stomach, usefulness of the intraoperative endoscopy to identify the location of the tumor, and the presence of intraluminal bleeding from the staple line, and how to apply the linear stapler in a transverse direction in a laparoscopic wedge resection for gastric GIST.
Laparoscopic total gastrectomy and D2 dissection guided by fluorescence imaging system, followed by esophagojejunostomy using an intracorporeal purse-string suture method
This video demonstrates a case of gastric cancer, which is located at the cardia, and a total gastrectomy was planned. For D2 dissection in a total gastrectomy, lymph node dissection around the splenic artery and splenic hilum is one of the most challenging area. Here, we present an example of complete dissection by following the plane around the splenic vessels.
Fluorescence imaging using indocyanine green (ICG) is a promising technology not only for sentinel node navigation surgery but it is also a guide for extensive lymph node dissection. The laparoscopic fluorescence imaging system was used here as a guidance and assessment tool for complete lymph node dissection. Also, an original method for intracorporeal esophagojejunal anastomosis is introduced, which enables purse-string suture and insertion of the anvil of the circular stapler in a quite stable manner, and reproduces conventional esophagojejunostomy without specialized devices.
HK Yang, SH Kong
Surgical intervention
4 years ago
2716 views
50 likes
1 comment
28:29
Laparoscopic total gastrectomy and D2 dissection guided by fluorescence imaging system, followed by esophagojejunostomy using an intracorporeal purse-string suture method
This video demonstrates a case of gastric cancer, which is located at the cardia, and a total gastrectomy was planned. For D2 dissection in a total gastrectomy, lymph node dissection around the splenic artery and splenic hilum is one of the most challenging area. Here, we present an example of complete dissection by following the plane around the splenic vessels.
Fluorescence imaging using indocyanine green (ICG) is a promising technology not only for sentinel node navigation surgery but it is also a guide for extensive lymph node dissection. The laparoscopic fluorescence imaging system was used here as a guidance and assessment tool for complete lymph node dissection. Also, an original method for intracorporeal esophagojejunal anastomosis is introduced, which enables purse-string suture and insertion of the anvil of the circular stapler in a quite stable manner, and reproduces conventional esophagojejunostomy without specialized devices.