胃粘膜下腫瘍に対する腹腔鏡および内視鏡協調手術の結果と体位変換手技を用いた我々のアプローチ

Tumor size or localization determines the operative procedure for gastric submucosal tumors. Laparoscopic and endoscopic cooperative surgery is a typical surgical procedure for gastric submucosal tumors. When the surgery was first introduced in 2012 in our hospital, the endoscopic mucosal incision was performed under laparoscopic view with the patient in a supine spread-leg position; however, since 2015, endoscopic manipulation has been performed in the left lateral decubitus position, and the surgery commences in the supine spread-leg position. We aimed to review the results of the laparoscopic and endoscopic cooperative surgeries performed at our hospital to evaluate its validity for gastric submucosal tumors. Sixty patients who underwent laparoscopic and endoscopic cooperative surgery were retrospectively evaluated for their characteristics, oncological factors, and short- and long-term outcomes. The early group comprised 15 patients who underwent surgery before the positional change technique was introduced, and the late group comprised 45 patients after the introduction. We compared the two groups. The most common tumor and location were gastrointestinal stromal tumor and the U region, respectively. The average tumor size and operative time were 2.6 cm and 124 min, respectively. No major complications were observed. The endoscopic manipulation time was significantly shorter in the late group, with a 26% reduction (42 min vs. 31 min, P = 0.006). The two groups showed no difference in the overall operative time. Laparoscopic and endoscopic cooperative surgery could be safely performed at our hospital. The positional change technique is useful because endoscopist can perform procedures with less stress without prolonging the operation time.