Non-exposed endoscopic wall-inversion surgery as a novel partial gastrectomy technique

Takashi Mitsui, Keiko Niimi, Hiroharu Yamashita, Osamu Goto, Susumu Aikou, Fumihiko Hatao, Ikuo Wada, Nobuyuki Shimizu, Mitsuhiro Fujishiro, Kazuhiko Koike, Yasuyuki Seto

Research output: Contribution to journalArticlepeer-review

78 Citations (Scopus)


In gastric full-thickness resection employing both endoscopy and laparoscopy, intraabdominal contamination or even possibly tumor seeding is unavoidable as a result of iatrogenic perforation and the resultant spread of gastric juice. To minimize contamination and resected tissue volume, we developed a new technique without perforation termed non-exposed endoscopic wall-inversion surgery (NEWS), and present here the preliminary results. In a clinical observation cohort study, NEWS was attempted in six patients with gastric SMT to investigate the procedure, mortality, and morbidity. NEWS consists of several steps: marking around a tumor on the mucosal as well as the serosal surface, submucosal injection of sodium hyaluronate with indigo carmine dye, circumferential seromuscular dissection with suture closure under laparoscopy, and circumferential mucosubmucosal incision under gastric endoscopy. The resected specimen is then retrieved perorally. Perforation occurred as a result of misidentification and technical inadequacy in the first three patients. After modification of the devices, the entire procedure was successfully achieved in the latter three. There were no complications in any of our six cases. NEWS allows en bloc full-thickness resection, theoretically avoiding contamination and tumor dissemination into the peritoneal cavity.

Original languageEnglish
Pages (from-to)594-599
Number of pages6
JournalGastric Cancer
Issue number3
Publication statusPublished - 2014 Jul
Externally publishedYes


  • Full-thickness resection
  • Gastrointestinal stromal tumor
  • Laparoscopic gastrectomy
  • Partial gastrectomy
  • Submucosal tumor

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology
  • Cancer Research


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