Gastric Submucosal Tumor Successfully Treated by Reduced Port Surgery: Report of Two Cases

Kazuto Tsuboi, MD¹, Yuya Nyumura, MD¹, Masashi Tsunematsu, MD¹, Yasuhiro Takeda, MD¹, Yu Kumagai, MD¹, Hiroaki Kitamura, MD¹, Takayuki Dotai, MD¹, Kazuhisa Yoshimoto, MD¹, Tetsuya Kajimoto, MD¹, Fumiaki Yano, MD, FACS², Nobuo Omura, MD³, Hideyuki Kashiwagi, MD¹, Katsuhiko Yanaga, MD, FACS². ¹Fuji City General Hospital, ²The Jikei University School of Medicine, ³Nishisaitama-Chuo National Hospital

Introduction: Laparoscopic surgery is now becoming the standard approach to surgical treatment of gastric submucosal tumor in developed countries. Recently, reduced port surgery is increasingly performed for such a condition in selected facilities. We experienced two cases of gastric submucosal tumor with exophytic growth which were were successfully treated by laparoscopic reduced port surgery.

Cases: The first patient was a 70-year-old male who was referred to our hospital for gastrointestinal stromal tumor of the stomach. The tumor was 60 mm in diameter and was located in the posterior wall of the mid-body of the stomach. The second patient was a 43-year-old female who was referred to our hospital for gastric schwannoma. The tumor was 40 mm in diameter and was bleeding from a delle. These two tumors were located in the posterior wall close to greater curvature of the stomach, which were far from the vagus nerve. We planned to perform reduced port surgery for both cases. The patients were placed in a supine position and the operator stood between the legs of the patient. At first, EZ access® port was inserted at the navel and three 5-mm trocars were placed. Additionally, one 5-mm trocar was placed under the costal arch along the left midclavicular line. After exposing the base of the tumor circumferentially, we used an Endo-loop® in order to grasp and pull the neck of the tumor. Then a part of the stomach was excised encompassing the tumor with an Endo-GIA®. The operation time was 52 and 43 minutes, respectively and intraoperative blood loss was minimal in each patient. The postoperative course of the two patients were uneventful and they remain free of recurrence.

Conclusion: Exophytic submucosal tumor of the stomach is a good indication for reduced port surgery.