[Feasible technique for laparoscopic wedge resection for gastric submucosal tumor-laparoscopy endoscopy cooperative...

Laparoscopic wedge resections are being applied increasingly for gastric submucosal tumors, such as gastrointestinal stromal tumor (GIST). In spite of this, no defined strategy exists to help the surgeon choose an appropriate laparoscopic technique for an individual on the basis of tumor characteristics such as location or size. We applied a laparoscopy- and endoscopy-cooperative surgery (LECS) for gastric wedge resection that is applicable for submucosal tumor resection independent of the tumor's location and size.

Thirty-eight patients underwent LECS for the resection of gastric submucosal tumors. Both mucosal and submucosal layers around the tumor were circumferentially dissected using endoscopic submucosal dissection (ESD) by intraluminal endoscopy. Subsequently, the seromusclar layers were laparoscopically dissected precisely on the three-quarter cut line around the tumor. The submucosal tumor was then exteriorized to the abdominal cavity and dissected with a standard endoscopic stapling device.

LECS was successful for all cases of dissecting the gastric submucosal tumor. The postoperative course was uneventful in all cases with no anastomosis leakage, stenosis, or bleeding.

LECS for dissection of gastric submucosal tumors such as GIST may be performed safely. In addition, the success of the procedure does not depend on the location of the tumor, such as the esophago-gastric junction or pyloric ring.