Endoscopic Surgery in Field of Gastroenterological Surgery -Its Problems and Future-

Tatsuo Yamakawa

Department of Surgery, University Hospital at Mizonokuchi, Teikyo University School of Medicine

With development of new instruments and technologies, endoscopic surgery has become one of the surgeon's armamentarium in benign or malignant diseases of gastrointestinal tract, because of its advantages including less postoperative pain, rapid recovery and short hospital stay. In this paper, new development of instruments including Endo-GIA (linear cutter), instrument for automatic anastomosis as well as ultrasonic aspirator and ultrasonic coagulation shears were introduced. Moreover an advent of technologies including laparoscopically assisted surgery and hand assisted laparoscopic surgery tremendously overcome the surgeon's handicaps involved in endoscopic surgery and makes advanced surgery possible. On the other hand, discussion was mainly focussed on the problems inherent to laparoscopic surgery indicated for the cases with cancerous diseases, especially port site recurrence. Port site recurrence seems to be secondary to multiple factors including the gas used, local trauma, tumor manipulation, bilologic properties of the tumor, and individual surgeon's skills. Therefore the most important thing is that laparoscopic surgery should be indicated for the cases in which radical cure can be expected. Moreover we surgeon should be versed in fundamental technique of cancer surgery that is so-called "no-touch" technique advocated by Turnbull and a tumor should be delivered through a plastic bag.

Key words
port site recurrence, endoscopic surgery, complications of endoscopic surgery

Reprint requests
Tatsuo Yamakawa Department of Surgery, University Hospital at Mizonokuchi, Teikyo University School of Medicine 3-8-3 Mizonokuchi, Takatsu-ku, Kawasaki, 213-8507 JAPAN

Accepted
May 25, 1999

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