Masao Fujiwara, MD1, Takayoshi Kishino, MD1, Hirohito Mori, MD2, Hideki Kobara, MD2, Tsutomu Masaki, MD2, Yasuyuki Suzuki, MD1. 1Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan, 2Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
Natural orifice transluminal endoscopic surgery (NOTES) is a minimally invasive surgery, but the procedures using only a flexible endoscope are technically demanding for gastrointestinal submucosal tumors. Meanwhile, surgical or laparoscopic resection sometimes results in inadequate resection because it is difficult to precisely recognize the border of tumor without an endoscope. Therefore, Laparoscopic and Endoscopic cooperative surgery (LECS) is one of ideal procedures in NOTES.
We have performed LECS for two patients with a duodenal submucosal tumor. Briefly, the tumor was resected endoscopically with 5mm safety margin of a full-thickness duodenal wall with the aid of a laparoscope. Then, layer-to-layer suture closure of the duodenum was completed laparoscopically. The specimen was removed through the mouth in both cases.
Both the tumors were resected en bloc with a negative surgical margin. Histologically, the first case was diagnosed gastrointestinal stromal tumor classified in the very low risk group in modified-Fletcher’s criteria, and the second case was diagnosed carcinoid (neuroendocrine tumor G1). The tumor size was 15 mm and 8mm, locating on the anterior wall of the descending part and the anterior wall of the duodenal bulb, respectively. The operating time was 154 min and 234 min, respectively, and estimated blood loss was less than 10ml and 125ml, respectively. The postoperative course was uneventful with no anastomosis leakage, stenosis, or bleeding in both cases. The length of postoperative hospital stay was 8 days each. We conclude that LECS can be safely and successfully performed even for small duodenal submucosal tumors.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78978
Program Number: P343
Presentation Session: Poster (Non CME)
Presentation Type: Poster