title: A novel technique to minimize deformation of the stomach in laparoscopic partial gastrectomy for intraluminal gastric GISTs.
abstract: BACKGROUND
  The laparoscopic approach would be difficult to perform without causing deformation of the stomach in managing gastrointestinal stromal tumors (GISTs) of the intraluminal type, especially in those that are located in the posterior gastric wall or around the gastroesophageal junction and the pylorus, because intraluminal GISTs usually require an excessive resection of the gastric wall for cure. We present a novel surgical technique for successful management of intraluminal gastric GISTs that minimizes deformation of the stomach regardless of tumor location.
  
  
  METHODS
  The operating surgeon handles the tumor by holding tissue surrounding the tumor and performs seromyotomy using an ultrasonically activated device along the outer edge of the tumor. The tumor gradually protrudes like an extraluminal tumor as the seromyotomy proceeds. When seromyotomy along the tumor comes up to the point where the tumor sufficiently turns over the gastric serosa, the tumor looks like a pedunculated extraluminal GIST. Two seromuscular sutures are applied to close the exfoliated seromuscular layer. The tips of two seromuscular sutures are held and then pulled up toward the ventral side so that the staple line is aligned in line with the minor axis of the stomach. Finally, complete tumor removal with minimal seromuscular resection is accomplished by applying a linear stapler.
  
  
  RESULTS
  All patients resumed oral ingestion on the day after surgery and showed no signs of anastomotic constriction or obstruction.
  
  
  CONCLUSIONS
  Our laparoscopic procedure for gastric GISTs is simple and allows us easy and precise removal of the tumor and closure of the gastric wall with minimum necessary resection, regardless of the location and growth form of the tumors.
authors.affiliation: Department of Digestive and General Surgery, Shimane University Faculty of Medicine , Shimane, Japan .
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Hirahara
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsubara
authors.forename: Akihiko
authors.initials: A
authors.lastname: Kidani
authors.forename: Ryoji
authors.initials: R
authors.lastname: Hyakudomi
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Fujii
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Tajima
mesh_terms: D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic / Q000601:surgery; D004435:Eating; D004943:Esophagogastric Junction / Q000473:pathology; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000601:surgery; D011708:Pylorus / Q000601:surgery; D012704:Serous Membrane / Q000601:surgery; D013274:Stomach Neoplasms / Q000601:surgery*; D013536:Suture Techniques; D059708:Ultrasonic Surgical Procedures / Q000379:methods