J Gastric Cancer.  2012 Sep;12(3):173-178.

Transumbilical Single-Incision Laparoscopic Wedge Resection for Gastric Submucosal Tumors: Technical Challenges Encountered in Initial Experience

• Park JY
• Eom BW
• Yoon H
• Ryu KW
• Kim YW
• Lee JH

Abstract

PURPOSE
To report the initial clinical experience with single-incision laparoscopic gastric wedge resection for submucosal tumors.
MATERIALS AND METHODS
The medical records of 10 patients who underwent single-incision laparoscopic gastric wedge resection between July 2009 and March 2011 were reviewed retrospectively. The demographic data, clinicopathologic and surgical outcomes were assessed.
RESULTS
The mean tumor size was 2.5 cm (range, 1.2~5.0 cm), and the tumors were mostly located on the anterior wall (4/10) or along the greater curvature (4/10), of the stomach. Nine of ten procedures were performed successfully, without the use of additional trocars, or conversion to laparotomy. One patient underwent conversion to multiport laparoscopic surgery, to get simultaneous cholecystectomy safely. The mean operating time was 66.5 minutes (range, 24~132 minutes), and the mean postoperative hospital stay was 5 days (range, 4~7 days). No serious perioperative complications were observed. Of the 10 submucosal tumors, the final pathologic report revealed 5 gastrointestinal stromal tumors, 4 schwannomas, and 1 heterotopic pancreas.
CONCLUSIONS
Single-incision laparoscopic gastric wedge resection for gastric submucosal tumors is feasible and safe, when performed by experienced laparoscopic surgeons. This technique provides favorable cosmetic results, and also short hospital stay and low morbidity, in carefully selected candidates.

Keyword

Stomach neoplasms; Gastrointestinal stromal tumors; Gastrectomy; Surgical procedures, minimally invasive

MeSH Terms

Cholecystectomy
Cosmetics
Gastrectomy
Gastrointestinal Stromal Tumors
Humans
Laparoscopy
Laparotomy
Length of Stay
Medical Records
Neurilemmoma
Retrospective Studies
Stomach
Stomach Neoplasms
Surgical Instruments
Surgical Procedures, Minimally Invasive
Cosmetics

Figure

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  Fig. 1 Home-made single-port device was made from small wound protractor and a surgical glove with conventional laparoscopic trocars.

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  Fig. 2 Operating time and tumor characteristics. The operating time varied according to tumor size and location, but generally tended to decline with the accumulation of the surgeon's experience. HPF = high power field; LB = lower body; MB = mid-body; GC = greater curvature; AW = anterior wall; PW = posterior wall; exo = exophytic; endo = endoluminal.

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  Fig. 3 Photograph of the abdomen taken 1 month after the operation shows excellent cosmesis with minimal scar.

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