LAPAROSCOPIC AND ENDOSCOPIC COOPERATIVE SURGERY FOR STOMACH SUBMUCOSAL TUMORS: CASE SERIES STUDY
Anh Nguyen Vu Tuan, Hai Nguyen Viet, Quoc Ho Le Minh, Long Vo Duy, Nhan Le Quang
Background Laparoscopic wedge resections are increasingly utilized to treat gastric submucosal tumors. However, laparoscopic wedge resection is not applicable for tumors located near the gastric inlet, or outlet, or posterior wall and requires resection of relatively large sections of normal gastric wall, particularly if laparoscopic linear staplers are used.
Methods. From Jan 2018 to May 2019, among 52 patients with gastric submucosal tumor were admitted, 5 consecutive patients underwent laparoscopic and endoscopic cooperative surgery (LECS) for resection of gastric SMTs. The procedure was performed under general anesthesia. The mucosal and submucosal layers around the tumor were circumferentially dissected by endoscopic submucosal dissection. Subsequently, the seromuscular layer involving three-fourths of the line of the incision around the tumor was laparoscopically dissected. The submucosal tumor was then exteriorized to the abdominal cavity and dissected with ultrasound devices and closed with barded sutures.
Results In all cases, the LECS procedure was successful in dissecting the gastric SMTs. The tumors were in the upper third of the stomach in one cases, in the middle third in three cases, and in the lower third in one cases. The mean operating time was 127.0 ± 38 minutes, and the mean intraoperative blood loss was 20.2 ± 6.4 ml. The postoperative course was uneventful in all cases. Conclusions We demonstrated the feasibility and satisfactory surgical outcomes after LECS for gastric SMT. With LECS, relatively small sections of normal gastric wall are resected without postoperative morbidity or mortality.
Conclusion . The LECS is safe and beneficial technique for resection of SMTs, even for those tumors located near the gastric inlet or outlet.