Ann Surg Treat Res.  2014 Dec;87(6):304-310. 10.4174/astr.2014.87.6.304.

Single-incision intragastric resection for upper and mid gastric submucosal tumors: a case-series study

• Choi CI
• Lee SH
• Hwang SH
• Kim DH
• Jeon TY
• Kim DH
• Kim GH
• Park DY

• KMID: 2167086
• DOI: http://doi.org/10.4174/astr.2014.87.6.304

Abstract

PURPOSE
Laparoscopic gastric wedge resection is a standard treatment for removing gastric submucosal tumors (SMTs). So far, however, there have been few reports of single-incision laparoscopic intragastric wedge resection. Our aim was to describe this procedure and our experience with it.
METHODS
From January 2010 to December 2013, a total of 21 consecutive patients with gastric SMTs underwent single-incision intragastric resection at our institution. Their clinicopathologic data were analyzed retrospectively.
RESULTS
The patients consisted of nine men and 12 women with a mean age of 51.9 +/- 12.9 years (22-69 years). Their mean body mass index was 22.6 +/- 2.0 kg/m2. Mean tumor size was 2.4 +/- 0.7 cm, with the following anatomic distribution: esophagogastric junction in three patients, fundus in twelve, upper body in three, and lower body in two. Mean operating time was 68.6 +/- 12.0 minutes. There were no conversions to open surgery and no major intraoperative complications. Time to resumption of water intake was 1.4 +/- 0.5 days. Mean hospital stay was 4.9 +/- 1.7 days. There were no recurrences or deaths during the mean 19-month follow-up.
CONCLUSION
Single-incision intragastric wedge resection is a feasible and safe procedure. It is especially efficient for treating small endophytic gastric SMTs located on the upper and mid portion of the stomach.

Keyword

Laparoscopy; Stomach neoplasm; Gastric mucosa; Gastrectomy; Gastrointestinal stromal tumors

MeSH Terms

Body Mass Index
Drinking
Esophagogastric Junction
Female
Follow-Up Studies
Gastrectomy
Gastric Mucosa
Gastrointestinal Stromal Tumors
Humans
Intraoperative Complications
Laparoscopy
Length of Stay
Male
Recurrence
Retrospective Studies
Stomach
Stomach Neoplasms

Figure

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  Fig. 1 Umbilical incision.

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  Fig. 2 (A) Gastric incision after inserting first wound retractor. (B) Pulling the stomach down by grasping with Babcock forcep.

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  Fig. 3 (A) Single port with glove, trocar, and wound retractor. (B) Illustration of single port application.

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  Fig. 4 (A) Endophytic mass was located at the apex of the fundus of the stomach. (B) Laparoscopic linear stapler was applied to the tumor. Tagging sutures were applied to pull up the tumor. (C) Remaining mass was resected with the second laparoscopic linear stapler. This procedure can be performed more easily through proper articulation of the stapler and tumor traction. (D) Resection line is observed. Bleeding control can be performed with sutures or electrocautery.

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  Fig. 5 Distribution of submucosal tumors in various portions of the stomach. The number in each circle indicates the frequency. EGJ, esophagogastric junction; UB, upper body; LC, lesser curvature; PW, posterior wall; LB, lower body; E, esophagus; S, stomach; D, duodenum.

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