'The parachute method': A novel technique for laparoscopic tumour handling

• Published in: Journal of minimal access surgery Vol. 20; no. 1; pp. 111 - 114
• Main Authors: Kashu, Noriaki, Nishiwaki, Noriyuki, Kagawa, Tetsuya, Kakishita, Tomokazu, Hato, Shinji
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01.01.2024; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow; Wolters Kluwer Medknow Publications
• Subjects: Analysis; Gastrointestinal cancer; How I Do It Differently; Laparoscopic surgery; Laparoscopy; Methods; submucosal tumour; Sutures; suturing technique; Tumors
• ISSN: 0972-9941; 1998-3921
• DOI: 10.4103/jmas.jmas_159_22

Although laparoscopic surgery for submucosal tumours (SMTs) may require multiple support threads, the traction direction of a single thread is only one option and cannot be freely changed. To solve this problem, we introduced a novel innovative technique for tumour handling, named 'the parachute method'. Prior to suturing, the surrounding vessel was treated when the tumour was located near the lesser or greater curvature. A monofilament thread was ligated in the serous muscle layer along the peritumoural markings with approximately five stitches in a row, with moderate deflection. Next, the other monofilament thread was passed through the deflection and ligated; this resembled a parachute shape that could be pulled in any direction over the entire circumference with uniform tension. We performed this procedure in three patients with extramural growth-type gastrointestinal stromal tumours of approximately 2-3 cm. The median suturing time was 10 minutes. Laparoscopic local resection of the stomach was safely performed, and the patients were discharged without any complications. In this study, we demonstrate a novel, simple, inexpensive, useful and reasonable technique for handling SMTs, named 'the parachute method'. We believe that this technique will have additional applications in cooperative surgery with endoscopy.