J Minim Invasive Surg.  2020 Dec;23(4):172-178. 10.7602/jmis.2020.23.4.172.

Laparoscopic Local Resection through Subserosal Dissection with Endoscopic Air-Insufflation for Submucosal Tumors Located Near the Esophagogastric Junction

• Kim IK
• Park JH
• Lee YJ
• Jeong SH
• Kim TH
• Kim DH
• Kim HG
• Cho JK
• Kim JM
• Kwag SJ
• Kim JY
• Jeong CY
• Ju Yt
• Jung EJ
• Hong SC

• KMID: 2509547
• DOI: http://doi.org/10.7602/jmis.2020.23.4.172

Abstract

Purpose
A novel resection method, namely, laparoscopic local resection through subserosal dissection with endoscopic air-insuff lation (LRSDEA) was used for submucosal tumors located near the esophagogastric junction (SMT-EGJ) to avoid major gastric resection.
Methods
A total of 9 cases underwent LRSDEA. We sequentially performed: laparoscopic dissections around EGJ, subserosal dissections around SMTs using laparoscopic electrocautery and ultrasonic shears, and finally, enucleation of SMTs. During these procedures, intraoperative endoscopic tumor localization, as well as endoscopic air-insufflation allowed for safe resection. These procedures are shown in the supplementary video clip. The clinicopathological characteristics and surgical results were analyzed.
Results
All laparoscopic procedures were successfully performed without requiring a major gastrectomy. The mean operation time was 126.1 minutes, and estimated blood loss was 12.0 ml. There were no postoperative complications. Pathological diagnoses were 6 leiomyomas, 2 gastrointestinal stromal tumors, and 1 gastric duplication.
Conclusion
LRSDEA is an effective and safe treatment option for SMT-EGJ, as major resection of the stomach is avoided.

Keyword

Laparoscopy; Stomach neoplasm; Gastrointestinal stromal tumor; Esophagogastric junction; Endoscopy