Preface: Embracing a New Era of “Super Minimally Invasive Surgery” . . . . . III
Preface: Pioneering the SMIS Philosophy . . . . . . . . . . . . . . . . . . . . . . . . . . . V
Super Minimally Invasive Surgery: An Inevitable Choice for Humanity . . . . . VII
Editorial Board . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XI
PART ONE
General Introduction to Super Minimally Invasive Surgery . . . . . . . . . . . . . . 1
CHAPTER 1
The Birth and Significance of Super Minimally Invasive Theory . . . . . . . . . . 3
1.1 The Rapid Development of Gastrointestinal Surgery, the Emergence of the Super Minimally Invasive Theory . . . . . . . . . . . . . . . . . . . . . . . 3
1.2 Super Minimally Invasive Theory Has Profound Guiding Significance for Future Surgical Therapeutics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1.3 Guided by the Super Minimally Invasive Theory, Super Minimally Invasive Surgery is Booming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
CHAPTER 2
The Super Minimally Invasive Theoretical System . . . . . . . . . . . . . . . . . . . . 17
2.1 The Definition and Implementation Principles of Super Minimally Invasive Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
2.2 The Four Channels of Super Minimally Invasive Surgery . . . . . . . . . . . 19
2.3 The Techniques of Super Minimally Invasive Surgery . . . . . . . . . . . . . 29
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
CHAPTER 3
Nomenclature in Super Minimally Invasive Surgery and Surgical
Record Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
3.1 Rules of Surgical Nomenclature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
3.2 Recording Rules for Super Minimally Invasive Surgery . . . . . . . . . . . . 64
3.2.1 SMIS Excision Methods and the Nomenclature of Endoscopic
Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
3.2.2 Examples of SMIS Surgical Records . . . . . . . . . . . . . . . . . . . . . 66
3.3 Surgical Items and Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
CHAPTER 4
Common Super Minimally Invasive Surgery Operations . . . . . . . . . . . . . . . . 75
4.1 Super Minimally Invasive Closure . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
4.1.1 SMIS Wound Closure Method . . . . . . . . . . . . . . . . . . . . . . . . . 75
4.1.2 Hot-Spot Issues and Progress in the Search for a Consensus . . . 84
4.2 Super Minimally Invasive Surgery for the Prevention and Therapy of Gastrointestinal Bleeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
4.2.1 Endoscopic Common Super Minimally Invasive Hemostatic Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
4.2.2 Hot-Spot Issues in the Consensus and Research Progress . . . . . 88
4.3 Super Minimally Invasive Auxiliary Traction Method . . . . . . . . . . . . . 89
4.3.1 Clip–Thread Combined Traction Method . . . . . . . . . . . . . . . . . 90
4.3.2 Clip–Elastic Ring Combined Traction Method . . . . . . . . . . . . . 90
4.3.3 Other Combinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
4.3.4 Hot-Spot Issues in the Consensus and Research Progress . . . . . 92
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
CHAPTER 5
Conditions for Performing Super Minimally Invasive Surgery . . . . . . . . . . . . 97
5.1 Site and Anesthesia Rules for Super Minimally Invasive Surgery . . . . . 97
5.1.1 Site Facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
5.1.2 Anesthesia Rules for Super Minimally Invasive Surgery . . . . . . 98
5.2 Manning and Requirements for Performing Super Minimally Invasive Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
5.2.1 Surgeon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
5.2.2 Anesthetist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
5.2.3 Nurse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
5.2.4 Operating Room Assistant . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
5.2.5 Operating Room Head Nurse . . . . . . . . . . . . . . . . . . . . . . . . . . 102
5.2.6 Cleaner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
5.2.7 Operation Room Technician. . . . . . . . . . . . . . . . . . . . . . . . . . . 103
5.2.8 Pathologist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
5.3 Instruments and Parameters of Super Minimally Invasive Surgery . . . . 104
5.3.1 Electrosurgical Device . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
5.3.2 Surgical Equipment for Endoscopic Therapy . . . . . . . . . . . . . . 109
5.4 Common Instruments and Articles for Super Minimally Invasive Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
5.5 Standardized Operation and Management of the Cleaning and Disinfection of Gastroendoscopes . . . . . . . . . . . . . . . . . . . . . . . . . 115
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
CHAPTER 6
Standard Process of Super Minimally Invasive Surgery . . . . . . . . . . . . . . . . . 119
6.1 Informed Consent Prior to Super Minimally Invasive Surgery . . . . . . . 119
6.1.1 Legal Basis and Moral Consideration of the Informed Consent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
6.1.2 The Contents and Requirements of Super Minimally Invasive Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
6.1.3 Practical Implementation of Informed Consent in Super Minimally Invasive Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
6.1.4 Postoperative Follow-Up Visit and Feedback . . . . . . . . . . . . . . 123
6.1.5 Difficulties and Strategy of Informed Consent in Super Minimally Invasive Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
6.2 Preoperative Conversation Skills in Super Minimally Invasive Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
6.2.1 Patient Psychological Profiling and Intervention of Super Minimally Invasive Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
6.2.2 Doctor–Patient Communication in Super Minimally Invasive Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
6.2.3 Information About Super Minimally Invasive Surgery (Surgical Purpose, Surgical Risk and Special Condition Inform) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
6.2.4 Example of Informational Conversation on Super Minimally Invasive Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
6.2.5 Complication Management Principle . . . . . . . . . . . . . . . . . . . . 128
6.3 Standards for the Surgical Record of Clinical Cases. . . . . . . . . . . . . . . 129
6.3.1 Basic Requirements for the Surgical Record . . . . . . . . . . . . . . . 129
6.3.2 Specific Contents of the Surgical Record in Super Minimally Invasive Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
6.3.3 Postoperative Treatment and Medical Order . . . . . . . . . . . . . . 130
6.3.4 Notice and Follow-Up Visit . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
6.3.5 Writing Norm and Notice . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
6.3.6 Specific Writing Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
6.4 Perioperative Diagnosis and Treatment Criteria . . . . . . . . . . . . . . . . . 132
6.4.1 Preoperative Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
6.4.2 Intraoperative Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
6.4.3 Postoperative Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
6.4.4 Prevention of Complications . . . . . . . . . . . . . . . . . . . . . . . . . . 133
6.4.5 Management of Follow-Up Visits . . . . . . . . . . . . . . . . . . . . . . . 134
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
CHAPTER 7
Preoperative Preparation and Treatment of Complications in Super Minimally Invasive Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
7.1 Preparation Before the Endoscopic Operation . . . . . . . . . . . . . . . . . . . 137
7.1.1 Preparation of the Endoscopic Operation of the Upper Digestive Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
7.1.2 Preparation of the Endoscopic Operation of the Lower Digestive Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
7.1.3 Preparation Before an Enteroscopic Operation . . . . . . . . . . . . . 141
7.1.4 Preparation Before an Operation by Duodenoscopy . . . . . . . . . 142
7.1.5 Preparation Before the Ultrasonic Endoscopy Examination . . . 142
7.1.6 Preparation Before the SpyGlass Operation . . . . . . . . . . . . . . . 143
7.1.7 Hot-Spot Issues in the Consensus . . . . . . . . . . . . . . . . . . . . . . . 143
7.2 Preoperative Preparation of the Patient for Super Minimally Invasive Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
7.2.1 Medical Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
7.2.2 Nursing Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
7.2.3 Hot-Spot Issues in the Consensus . . . . . . . . . . . . . . . . . . . . . . . 148
7.3 Wound Pre-Treatment and Infection Prevention in Super Minimally Invasive Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
7.3.1 Wound Pre-Treatment Plan in Super Minimally Invasive Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
7.3.2 Antibiotic Application in Super Minimally Invasive Surgery . . . 152
7.3.3 Hot-Spot Issues in the Consensus . . . . . . . . . . . . . . . . . . . . . . . 156
7.4 Prevention and Treatment of Intraoperative Complications in Super Minimally Invasive Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
7.4.1 Complication Prevention and Treatment . . . . . . . . . . . . . . . . . 157
7.4.2 Hot-Spot Issues in the Consensus . . . . . . . . . . . . . . . . . . . . . . . 159
7.5 Prevention and Treatment of Postoperative Complications in Super Minimally Invasive Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
7.5.1 Complication Prevention and Treatment . . . . . . . . . . . . . . . . . 160
7.5.2 Hot-Spot Issues in the Consensus . . . . . . . . . . . . . . . . . . . . . . . 164
7.6 Postoperative Nursing in Super Minimally Invasive Surgery . . . . . . . . 167
7.6.1 Peroral Super Minimally Invasive Surgery . . . . . . . . . . . . . . . . 167
7.6.2 Psychological Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
7.6.3 Health Education. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
7.6.4 Transanal Super Minimally Invasive Surgery . . . . . . . . . . . . . . 171
7.6.5 Hot-Spot Issues in the Consensus . . . . . . . . . . . . . . . . . . . . . . . 174
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
PART TWO
Specific Discussion of Super Minimally Invasive Surgery . . . . . . . . . . . . . . . . 183
CHAPTER 8
Super Minimally Invasive Surgery of Esophageal Diseases . . . . . . . . . . . . . . . 185
8.1 Early Esophageal Carcinoma and Super Minimally Invasive Surgery . . 185
8.1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
8.1.2 Peroral Super Minimally Invasive Surgery with Non-Full-Thickness Resection for the Treatment of Early Esophageal Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . 187
8.1.3 Non-Full-Thickness Resection of Early Esophageal Carcinoma by Per-Tunnel Super Minimally Invasive Surgery . . 195
8.1.4 Esophageal Skin Grafting by Digestive Endoscopic Super Minimally Invasive Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
8.2 Super Minimally Invasive Surgery of Esophageal Subepithelial Lesions . 205
8.2.1 General Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
8.2.2 Peroral Super Minimally Invasive Resection of Esophageal Subepithelial Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
8.2.3 Per-Tunnel Super Minimally Invasive Resection of Esophageal Subepithelial Lesions . . . . . . . . . . . . . . . . . . . . . 210
8.2.4 Super Minimally Invasive Resection Per-Multi Cavity of Esophageal Subepithelial Lesions . . . . . . . . . . . . . . . . . . . . . 215
8.3 Super Minimally Invasive Radiofrequency Ablation for Intraepithelial Neoplasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
8.3.1 Principle of Radiofrequency Ablation . . . . . . . . . . . . . . . . . . . . 217
8.3.2 Indications and Contraindications of Super Minimally Invasive RFA Surgery . . . . . . . . . . . . . . . . . . . . . . . 218
8.3.3 Preoperative Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
8.3.4 Surgical Operation and Skills . . . . . . . . . . . . . . . . . . . . . . . . . . 220
8.3.5 Postoperative Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
8.3.6 Postoperative Follow-Up Visit . . . . . . . . . . . . . . . . . . . . . . . . . 221
8.3.7 Hot-Spot Issues in the Consensus and Progress of the Study . . 221
8.4 Super Minimally Invasive Surgery for Esophageal Stricture . . . . . . . . . 222
8.4.1 Esophageal Stenosis Peroral Super Minimally Invasive Incision + Submucosal Injection . . . . . . . . . . . . . . . . . 223
8.4.2 Peroral Super Minimally Invasive Dilation of Esophageal Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
8.5 Super Minimally Invasive Surgery for Gastroesophageal Reflux Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
8.5.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
8.5.2 Peroral Super Minimally Invasive Radiofrequency Ablation to Cure Gastroesophageal Reflux Disease . . . . . . . . . . . . . . . . . 232
8.5.3 Peroral Incisionless Fundoplication for Gastroesophageal Reflux Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
8.5.4 Peroral Super Minimally Invasive Mucosa Resection for Gastroesophageal Reflux Disease . . . . . . . . . . . . . . . . . . . . 238
8.5.5 Clip Band Ligation Anti-Reflux Therapy for Gastroesophageal Reflux Disease . . . . . . . . . . . . . . . . . . . . 240
8.6 Super Minimally Invasive Peroral Myotomy of Esophageal Diverticula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
8.6.1 Diagnosis of Esophageal Diverticula . . . . . . . . . . . . . . . . . . . . . 244
8.6.2 STESD’s Indication and Contraindication . . . . . . . . . . . . . . . . 244
8.6.3 Preoperative Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244
8.7 Super Minimally Myotomy for Achalasia . . . . . . . . . . . . . . . . . . . . . . . 249
8.7.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
8.7.2 Per-Tunnel Super Minimally Myotomy for Achalasia . . . . . . . . 250
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
CHAPTER 9
Super Minimally Invasive Surgery of Gastric Diseases . . . . . . . . . . . . . . . . . . 265
9.1 Super Minimally Invasive Surgery for Early Gastric Cancer. . . . . . . . . 265
9.1.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
9.1.2 Peroral Super Minimally Invasive Surgery by Non-Full-Thickness Resection for Early Gastric Cancer . . . . 266
9.1.3 Super Minimally Invasive Full-Thickness Resection for Early Gastric Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
9.1.4 Early Gastric Cancer: Super Minimally Invasive Resection via the Tunnel Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
9.1.5 Early Gastric Cancer Treated with Multi-Channel Super Minimally Invasive Resection . . . . . . . . . . . . . . . . . . . . . . . . . . 288
9.2 Super Minimally Invasive Surgery for Gastric Low-Grade Intraepithelial Neoplasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
9.2.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
9.2.2 Low-Grade Intraepithelial Neoplasia of the Stomach: Peroral Super Minimally Invasive Radiofrequency Ablation . . . . . . . . . 293
9.2.3 Low-Grade Gastric Intraepithelial Neoplasia: Super Minimally Invasive Argon Plasma Coagulation . . . . . . . . . . . . 297
9.2.4 Low-Grade Gastric Intraepithelial Neoplasia: Super Minimally Invasive Holmium Laser Therapy . . . . . . . . . . . . . . 298
9.3 Super Minimally Invasive Resection of Gastric Subepithelial Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
9.3.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
9.3.2 Super Minimally Invasive Resection of Gastric Subepithelial Tumors . . . .. . . . . . 302
9.3.3 Peroral Super Minimally Invasive Full-Thickness Resection of Gastric Subepithelial Tumors . . . . . . . . . . . . . . . . . . . . . . . . 307
9.3.4 Peroral Super Minimally Invasive Non-Full-Thickness Resection of Gastric Subepithelial Tumors . . . . . . . . . . . . . . . . 312
9.3.5 Trans-Multi-Cavitary Super Minimally Invasive Resection of Gastric Subepithelial Tumors . . . . . . . . . . . . . . . . . . . . . . . . 315
9.4 Super Minimally Invasive Surgery for Gastroparesis . . . . . . . . . . . . . . 317
9.4.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
9.4.2 Super Minimally Invasive Tunnel Myotomy for Gastroparesis. . 318
9.4.3 Gastric Peroral Super Minimally Invasive Botulinum Toxin Injection (BoNT) .. . . . . . 324
9.4.4 Peroral Super Minimally Invasive Pyloric Stenting for Gastroparesis . . . .. . 325
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
CHAPTER 10
Super Minimally Invasive Therapies for Duodenal Diseases . . . . . . . . . . . . . . 333
10.1 Peroral Super Minimally Invasive Resection for Early Duodenal Cancer . . . .. . . . . . . 333
10.2 Peroral Super Minimally Invasive Resection of Duodenal Papillary Adenomas . . . . .. . . . . 338
10.2.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
10.3 Peroral Super Minimally Invasive Resection of Subepithelial Duodenal Tumors . . . . .. . . . . 342
10.4 Peroral Super Minimally Invasive Resection of Duodenal Polyps . . . . 348
10.4.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348
10.4.2 Diagnosis of Duodenal Polyps . . . . . . . . . . . . . . . . . . . . . . . . 348
10.4.3 Indications and Contraindications . . . . . . . . . . . . . . . . . . . . . 349
10.4.4 Preoperative Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
10.4.5 Surgical Procedure and Techniques . . . . . . . . . . . . . . . . . . . . 349
10.4.6 Hot-Spot Issues and Research Progress in the Consensus . . . . 353
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 354
CHAPTER 11
Super Minimally Invasive Surgery for Biliary Diseases. . . . . . . . . . . . . . . . . . 357
11.1 Choledocholithiasis and Cholangitis – Super Minimally Invasive Surgery . . . . . .. . . . . . . 357
11.1.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357
11.1.2 Endoscopic Super Minimally Invasive Retrieval of Choledocholithiasis via a Duodenal Papillary Supporter Under Direct Visualization of the Bile Duct Scope . . . . . . . . . 358
11.1.3 Peroral Super Minimally Invasive Papillotomy . . . . . . . . . . . . 363
11.1.4 Acute Suppurative Cholangitis and Peroral Super Minimally Invasive Drainage. . . .. . . . 366
11.2 Super Minimally Invasive Surgery of Biliary Strictures . . . . . . . . . . . 370
11.2.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 370
11.2.2 Super Minimally Invasive Dilatation for Biliary Stricture at the Duodenal Papilla . . .. . . . . 371
11.2.3 Biliary Stricture: Super Minimally Invasive Endoscopic Stent Placement at the Duodenal Papilla . . . . . . . . . . . . . . . . 373
11.2.4 Biliary Stricture: Diagnosis and Treatment with Peroral Cholangiopancreatoscopy (POC) Under Direct Visualization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378
11.3 Super Minimally Invasive Drainage for Biliary Fistulae . . . . . . . . . . . 382
11.4 Super Minimally Invasive Surgery for Gallbladder Stones and Cholecystitis . .. . . . . . . . . . 386
11.4.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 386
11.4.2 Gallbladder Stones: Super Minimally Invasive Stone Removal via the Duodenal Papilla . . . . . . . . . . . . . . . . . . . . . 387
11.4.3 Percutaneous Ultrasound-Endoscopic Guided Aspiration for Acute Suppurative Cholecystitis . . . . . . . . . . . . . . . . . . . . 391
11.5 Endoscopic Super Minimally Invasive Resection of Biliary Polyps . . . 395
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 398
CHAPTER 12
Super Minimally Invasive Surgery for Pancreatic Diseases . . . . . . . . . . . . . . . 405
12.1 Super Minimally Invasive Sclerotherapy with Polidocanol via Puncture Approach for Pancreatic Cystic Neoplasms. . . . . . . . . . . . . 405
12.1.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405
12.1.2 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406
12.1.3 Indications and Contraindications for Endoscopic Polidocanol Ablation of Pancreatic Cystic Neoplasms. . . . . . . 407
12.1.4 Preoperative Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407
12.1.5 Surgical Procedure and Techniques (Figure 12.1) . . . . . . . . . . 408
12.1.6 Postoperative Management . . . . . . . . . . . . . . . . . . . . . . . . . . 410
12.1.7 Postoperative Follow-Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410
12.1.8 Hot-Spot Issues and Research Progress in the Consensus . . . . 410
12.2 Super Minimally Invasive Removal of Pancreatic Duct Stones . . . . . . 411
12.2.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411
12.2.2 Endoscopic Super Minimally Invasive Removal of Pancreatic Duct Stones via the Duodenal Papilla + Extracorporeal Shockwave Lithotripsy (ESWL) . .. . . 412
12.2.3 Pancreatic Duct Stones and Super Minimally Invasive Stone Removal via Pancreatoscopy . . . . . . . . . . . . . . . . . . . . . . . . . 416
12.3 Pancreatic Fistula – Super Minimally Invasive Drainage via the Duodenal Papilla . .. . . . . . . . . . 419
12.3.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419
12.3.2 Diagnosis of Pancreatic Fistula . . . . . . . . . . . . . . . . . . . . . . . 419
12.3.3 Indications and Contraindications for Endoscopic Super Minimally Invasive Drainage of Pancreatic Fistula . . . . . . . . . 420
12.3.4 Surgical Methods and Procedures. . . . . . . . . . . . . . . . . . . . . . 420
12.3.5 Hot-Spot Issues in the Consensus . . . . . . . . . . . . . . . . . . . . . . 421
12.4 Pancreatic Walled-Off Necrosis: Super Minimally Invasive Drainage via Gastric Puncture Channel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422
12.4.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422
12.4.2 Diagnosis of WON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422
12.4.3 Indications and Contraindications . . . . . . . . . . . . . . . . . . . . . 422
12.4.4 Surgical Procedures and Techniques . . . . . . . . . . . . . . . . . . . . 423
12.4.5 Postoperative Management . . . . . . . . . . . . . . . . . . . . . . . . . . 425
12.4.6 A Classic Case . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425
12.4.7 Hot-Spot Issues and Research Progress in the Consensus . . . . 426
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427
CHAPTER 13
Super Minimally Invasive Surgery of Colorectal Diseases . . . . . . . . . . . . . . . . 431
13.1 Resection of Early Colorectal Cancer by Super Minimally Invasive Surgery . . . .. . .. . . . . . 431
13.1.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431
13.1.2 Transanal Super Minimally Invasive Non-Full-Thickness Resection for Early Colorectal Cancer . . . . . . . . . . . . . . . . . . 434
13.1.3 Transanal Super Minimally Invasive Full-Thickness Resection of Colorectal Cancer .. . . . 444
13.1.4 Early Rectal Cancer: Endoscopic Submucosal Tunnel Dissection . . . .. . . . . . 450
13.2 Super Minimally Invasive Resection of Colorectal Subepithelial Lesions . .. . . . 455
13.2.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455
13.2.2 Transanal Super Minimally Invasive Resection of Colorectal Submucosal Tumors . . . . . . . . . . . . 457
13.2.3 Neoadjuvant Therapy Followed by Transanal Super Minimally Invasive Resection of Rectal Stromal Tumors . . . . . 463
13.3 Super Minimally Invasive Resection of Laterally Spreading Tumors in the Colon and Rectum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 466
13.3.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 466
13.3.2 Endoscopic Super Minimally Invasive Resection of Laterally Spreading Tumors (LST) in the Rectum. . . . . . . . . . . . . . . . . 469
13.4 Appendiceal Diseases – Super Minimally Invasive Surgery . . . . . . . . . 474
13.4.1 Acute Appendicitis – Super Minimally Invasive Drainage via the Anus . . . .. . . . . . . 474
13.4.2 Super Minimally Invasive Trans-Rectal Removal of Appendicoliths using Endoscopic Retrograde Appendicitis Therapy (ERAT) . . . . . . . . . . . . . . . . . . . . . . . . 477
13.4.3 Periappendiceal Abscess – Super Minimally Invasive Trans-Rectal Drainage . . . . .. . . 479
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 483
CHAPTER 14
Super Minimally Invasive Surgery for Other Systemic Diseases . . . . . . . . . . . 489
14.1 Super Minimally Invasive Weight Loss Surgery for Obesity . . . . . . . . 489
14.1.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 489
14.1.2 Intragastric Balloon Placement for Weight Loss . . . . . . . . . . . 491
14.1.3 Endoscopic Sleeve Gastroplasty (ESG) . . . . . . . . . . . . . . . . . . 495
14.1.4 Endoluminal Vertical Gastroplasty (EVG) . . . . . . . . . . . . . . . 498
14.1.5 Endoscopic Duodenojejunal Bypass Sleeve (EDJBS) . . . . . . . 501
14.1.6 Endoscopic Gastro-Duodenal-Jejunal Bypass Sleeve Surgery. . 505
14.2 Super Minimally Invasive Drainage of Mediastinal and Abdominopelvic Abscesses . . . . . 507
14.2.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 507
14.2.2 Clinical Symptoms and Diagnosis . . . . . . . . . . . . . . . . . . . . . . 507
14.2.3 Indications and Contraindications of Super Minimally Invasive Drainage via Gastrointestinal Endoscopy . .. . . 508
14.2.4 Preoperative Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 508
14.2.5 Surgical Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 509
14.2.6 Postoperative Management . . . . . . . . . . . . . . . . . . . . . . . . . . 509
14.2.7 Hot-Spot Issues and Discussion in the Consensus . . . . . . . . . . 510
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 511
Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 513
