Introduction: Laparoscopic resection of tumors on upper portion of the stomach, especially when they are located at the posterior wall or greater curvature, is both difficult and time consuming. In order to overcome these difficulties, we introduce a new technique through right lateral decubitus position for laparoscopic resection of submucoal tumor (SMT) on upper portion of the stomach.
Methods and procedures: This retrospective study involved 31 patients who had been preoperatively diagnosed with SMT on upper portion of the stomach underwent laparoscopic wedge resection from January 2007 to September 2009. Twenty patients were treated by conventional approach (Conventional group) using 4~5 trocars including umbilical camera port. Remained 11 patients were undertaken operation on right lateral decubitus position (RLD group) through three to four left subcostal trocars, the first trocar was inserted under guidance of 5mm, 0 degree scope which was placed into inserting trocar.
Results: There were no differences in the age, sex, BMI, and history of previous abdominal operation between two groups. The tumor size was larger in conventional group (4.6±1.8 vs. 3.0±1.1). The RLD group used less trocars (3.3±0.5 vs. 4.2±0.4, p<0.001), and had shorter operation time (97.7±49.4 min vs. 168.3±60.2 min, p=0.002) and smaller amount of blood loss during operation (33.8±29.5 ml vs. 185.0±121.2 ml, p<0.001). These differences are more remarkable when the tumors are located at the posterior wall or greater curvature side of the stomach. The morbitidy was no significantly different between two groups.
Conclusions: Laparoscopic wedge resection through right lateral decubitus position is a safe and effective new technique for SMTs on upper portion of the stomach, especially when they are located at the posterior wall or greater curvature. And we need more experience for significant results.
Program Number: P525