NEWS : APPLICATION AND PROCEDURE

Abstract

Nonexposed endoscopic wall-inversion surgery (NEWS) is a laparoscopy-assisted endoscopic full-thickness resection technique without transmural communication, which can theoretically avoid intra-abdominal contamination or iatrogenic tumor seeding on the peritoneum. It is applied to perorally retrievable protruded or intraluminal-type subepithelial tumors or possibly node-negative early gastric cancers that are difficult to resect by endoscopy. Furthermore, by combining it with sentinel node navigation surgery, the application can be expanded to possibly node-positive early gastric cancers as a less invasive, function-preserving surgery. The NEWS procedure has many new and challenging steps : placing accurate serosal markings, laparoscopic seromuscular incision and suturing, endoscopic mucosal incision around the inverted lesion, and submucosal incision close to the suture. Although many issues remain to be solved, NEWS is expected to become the ideal minimally invasive surgery for gastric neoplasms.