title: Successful gastric submucosal tumor resection using laparoscopic and endoscopic cooperative surgery.
abstract: BACKGROUND
  Laparoscopic wedge resections are increasingly utilized to treat gastric submucosal tumors (SMTs). However, laparoscopic wedge resection is not applicable for tumors located near the gastric inlet or outlet and requires resection of relatively large sections of healthy stomach, particularly if laparoscopic linear staplers are used.
  
  
  METHODS
  Twenty 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 using endoscopic submucosal dissection via intraluminal endoscopy. 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 an endoscopic linear stapling device.
  
  
  RESULTS
  In all cases, the LECS procedure was successful in dissecting the gastric SMT. The tumor was located in the upper third of the stomach in eight cases, in the middle third in eight cases, and in the lower third in four cases. The mean operating time was 157.0 ± 68.4 minutes, and the mean intraoperative blood loss was 3.5 ± 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 healthy gastric wall are resected without postoperative morbidity or mortality. Thus, LECS is safe, easy, and beneficial for laparoscopic resection of SMTs, although care should be taken to avoid gastric juice contamination.
authors.affiliation: Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan. tsujihi@ndmc.ac.jp
authors.forename: Hironori
authors.initials: H
authors.lastname: Tsujimoto
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Yaguchi
authors.forename: Isao
authors.initials: I
authors.lastname: Kumano
authors.forename: Risa
authors.initials: R
authors.lastname: Takahata
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ono
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hase
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000601:surgery*; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome