Novel method for hybrid endo-laparoscopic full-thickness gastric resection using laparoscopic transgastric suture passer device

Current surgical methods for partial gastric full-thickness resections (FTRs) are limited by long operative times and risk of gastric content spillage, especially for lesions located at the posterior wall. We propose a simplified hybrid approach to FTR with reduced risk of spillage. Resection margins were marked by endoscopic electrocautery to simulate a gastric lesion in the upper third of the posterior wall in eight pigs. A custom-made laparoscopic "suture passer" was made of a sharpened bendable dissecting forceps. Full-thickness sutures were alternatively passed from the serosa side with the suture passer through the gastric wall and grabbed endoluminally using an endoscopic grasper and vice versa. These transgastric sutures formed either a purse string (PS; n = 4) or a continuous horizontal mattress (HM; n = 4). Sutures were then fastened from the laparoscopic side, resulting in external outpouching of the lesion. The pouch was transected using 45-mm linear staplers. Operative time, resection margins, and number of staplers were evaluated. The combined approach allowed one to precisely place the sutures around the pseudo lesions, despite the inflated stomach, and it included all target markings. PS and HM methods were similar regarding time for transgastric suture (780 s +/- A 219.1 s vs. 765 s +/- A 179.2 s, p = .885), resection margins (1.3 +/- A 1.0 cm vs. 0.8 +/- A 0.6 cm, p = .248), and number of staplers (3.8 +/- A 1.0 vs 3.3 +/- A 0.5, p = .405). Stapling time (600 s +/- A 189.7 s vs. 330 s +/- A 24.5 s, p = .028) was significantly shorter in the HM technique. FTR with laparo-endoscopic transgastric suture application was feasible in the animal model. This technique allows one to achieve accurate resection margins with minimal risk of spillage.