Laparoscopic intragastric resection of gastric submucosal tumor using the combination of laparoscopy and oral endoscopy

Nobumi Tagaya, PhD, Yuhei Hakozaki, MD, Natsuki Yamaguchi, MD, Mayuka Shimada, MD, Mariko Oya, MD, Yoshikiyo Matsunaga, MD, Teppei Tatsuoka, MD, Yawara Kubota, Kosuke Hirano, MD, Asami Suzuki, MD, Kazuyuki Saito, MD, Takashi Okuyama, PhD, Yoshitake Sugamata, PhD, Masatoshi Oya, PhD. Department of Surgery, Dokkyo Medical University Koshigaya Hospital

Introduction: Recently surgical resection of gastric submucosal tumors (GSTs) has been increased to perform by laparoscopic approaches. The combination of laparoscope and oral endoscope is mandatory to ensure a feasible and safe intragastric approach. Here we report our outcomes of laparoscopic intragastric resection for GSTs using laparoscope and oral endoscope.

Patients and Methods: We performed laparoscopic intragastric resection of GSTs in 20 patients (M:F= 8:12). Their mean age was 61 years (range: 34-75). We selected two approaches: 1) two or three ports were directly inserted into the stomach (standard approach: SA), or 2) the stomach was directly opened through a 2.5-cm single skin incision at the umbilicus (umbilical approach: UA). Both approaches were completed under the guidance of oral endoscope and laparoscope.

Results: Laparoscopic intragastric resection was successful in all patients (SA: 17 patients, UA: 3 ones). The mean maximum tumor diameter, operation time and blood loss in SA and UA were 26.0 and 33.7 mm, 168 and 80 min and 16 and 8 ml, respectively. One patient in SA required a gastrostomy to remove the tumor. There was one case of postoperative bleeding. The mean postoperative hospital stay in SA and UA were 7.8 and 7.7 days, respectively. There were no recurrences during a mean follow-up period of 97.4 months. The use of an oral endoscope revealed the help for port placement in the stomach, visual assistance during laparoscopic intragastric resection, retrieval of the specimen via the mouth, and a final check for the presence of air leakage or bleeding from after re-inflation of the stomach.

Conclusion: Laparoscopic intragastric surgery using oral endoscopy can be considerably beneficial for patients with GSTs located in the upper and middle part of the stomach, and when combined with laparoscopic procedures, minimal surgical invasiveness can be safely achieved.

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