Laparoscopic Wedge Resection for Gastric Submucosal Tumor Using Laparoscopic and Endoscopic Cooperative Surgery (lecs)

Yasushi Rino, PhD, Norio Yukawa, PhD, Roppei Yamada, PhD, Tsutomu Sato, PhD, Masanori Inamori, PhD, Yasunobu Abe, PhD, Tomoko Koide, PhD, Takashi Oshima, PhD, Toshio Imada, PhD, Munetaka Masuda, PhD. Department of Surgery, Yokohama City University


Laparoscopic wedge resections are increasingly applied for gastric submucosal tumors such as gastrointestinal stromal tumor (GIST). Despite this, no defined strategy exists to guide the surgeon in choosing the appropriate laparoscopic technique for an individual case on the basis of tumor characteristics such as location or size. A laparoscopic and endoscopic cooperative surgery (LECS) is applicable for submucosal tumor resection independent of tumor location and size.
We employed LECS for the resection of gastric submucosal tumors. Four patients underwent LECS for the resection of GIST. Both mucosal and submucosal layers around the tumor were circumferentially dissected using endoscopic submucosal dissection via intraluminal endoscopy. Subsequently, the seromusclar layer was laparoscopically dissected on the exact three-fourths cut line around the tumor. The submucosal tumor then was exteriorized to the abdominal cavity and dissected with a standard endoscopic stapling device.
In all cases, the LECS procedure was successful for dissecting out the gastric submucosal tumor. In one of four cases, the tumor was more than 5cm in diameter and located in the lower gastric portion near the pyloric ring. In three of four cases, the tumor was located in the upper gastric portion near the esophagogastric junction. The mean operation time was 162±13 min, and the estimated blood loss was 20±20 ml.
The postoperative course was uneventful in all cases.
The LECS procedure for dissection of gastric submucosal tumors such as GIST may be performed safely with reasonable operation times, less bleeding, and adequate cut lines. In addition, the success of the procedure does not depend on the tumor location such as the vicinity of the esophagogastric junction or pyloric ring.

Session Number: Poster – Poster Presentations
Program Number: P613
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