New Technique for Laparoscopic Wedge Resection for Gastric Submucosal Tumor: (Laparoscopy Endoscopy Cooperative Surgery)

Naoki Hiki, Tetsu Fukunaga, Akira Miki, Masanori Tokunaga, Shigekazu Ohyama, Yasuyuki Seto, Masatoshi Ohya, Junji Yamamoto, Akio Saiura and Toshiharu Yamaguchi

Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research

Background: Despite the spread of laparoscopic wedge resection for gastric submucosal tumor, there remains a problem on removal of the excess mucosa in resecting a tumor with intraluminal growth, which sometimes leads to postoperative deformity of the stomach. In addition, distal or proximal gastrectomy may replace in cases located around the pyloric ring or esophago-gastric junction. Then we have developed a new technique, Laparoscopy and Endoscopy Cooperative Surgery (LECS) which is an effective approach for submucosal tumor regardless of characteristics. Methods: A total of 12 patients underwent LECS between July 2006 and July 2007 in our hospital. In LECS, resection line is determined from within the abdominal cavity using endoscopic submucosal dissection (ESD). A seromuscular incision is made laparoscopically and lesion is then removed. Operation time, intraoperative blood loss, number of staplers, conversion to open surgery, postoperative gastric dilatation, time to oral intake, hospital stay were compared with 17 cases with conventional laparoscopic approach. Results: LECS was completed successfully in all patients including cases adjacent to the esophago-gastric junction or pyloric ring; neither conversion to open surgery nor complications were occurred. Surgical outcomes were comparable to those of conventional procedure. Mean operation time was about 30 minutes-longer and postoperative blood loss was 12 ml more than conventional approach. The number of staplers used for excision in LECS (2.1±0.8 pieces) was significantly less than conventional group (3.2±0.5 pieces). Conclusions: LECS is an effective procedure for resecting a submucosal gastric tumor with minimum removal of the stomach wall. In addition, this approach can be applied for lesions located at the vicinity of the esophago-gastric junction or pyloric ring.

Key words
gastric submucosal tumor, gastrointestinal submucosal tumor (GIST), endoscopic submucosal dissection (ESD), laparoscopic wedge resections

Reprint requests
Naoki Hiki Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research
3-10-6 Ariake, Koto-ku, 135-8550 JAPAN

Accepted
February 20, 2008

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