The Role of Oral Endoscope during Laparoscopic Intragastric Surgery of Gastric Submucosal Tumor

Research Article

Austin J Gastroenterol. 2015; 2(5): 1053.

The Role of Oral Endoscope during Laparoscopic Intragastric Surgery of Gastric Submucosal Tumor

Tagaya N*, Hakozaki Y, Yamaguchi N, Shimada M, Oya M, Matsunaga Y, Tatsuoka T, Kubota Y, Hirano K, Suzuki A, Saito K, Yamagata Y, Koketsu S, Okuyama T, Sugamata Y, Sameshima S and Oya M

Department of Surgery, Dokkyo Medical University Koshigaya Hospital, Japan

*Corresponding author: Nobumi Tagaya, Department of Surgery, Dokkyo Medical University Koshigaya Hospital, Japan

Received: July 14, 2015; Accepted: September 09, 2015; Published: September 11, 2015

Abstract

Introduction: Recently the surgical resection of Gastric Submucosal Tumor (GST) has been adapted to laparoscopic approaches. The use of an oral endoscope is required to accomplish a feasible and safe intragastric approach. Here we report the role of oral endoscope during laparoscopic intragastric surgery of GSTs.

Patients and Methods: We performed laparoscopic intragastric resection of GSTs in 20 patients. We selected two approaches; 1) Two or three ports were directly inserted into the stomach, or 2) The stomach was directly opened through a 2.5-cm single skin incision at umbilicus. Both approaches were completed under the guidance of oral endoscope.

Results: Laparoscopic intragastric resection was successful in all patients. The mean maximum tumor diameter, operation time and blood loss were 27.1 mm 155 min and 14ml, respectively. One patient required a gastrostomy to remove the tumor. There was one postoperative bleeding. The mean postoperative hospital stay was 7.7 days. There were no recurrences during a mean follow-up period of 97.4 months. The use of an oral endoscope lead a determination of the port placement in the stomach, a visual supplement of laparoscopic intragastric resection, a retrieval of the specimen via the mouth, and a final check of the presence of air leakage or bleeding from after re-inflation of the stomach.

Conclusion: Intragastric surgery using oral endoscopy can be considerably beneficial for patients with GSTs located in the upper and middle part of the stomach. The significance of oral endoscopy during laparoscopic procedures was emphasized from the viewpoint of minimal surgical invasiveness.

Keywords: Laparoscopic treatment; Intragastric resection; Gastric submucosal tumor; Oral endoscope; Stomach

Introduction

Recently the surgical resection of Gastric Submucosal Tumor (GST) has been adapted to a laparoscopic approach as a result of similar surgical outcomes of open procedure [1]. The selection of several laparoscopic approaches greatly depends on the characteristics of the tumor, including its size or location, and also the experience and skill of the surgeon. We have previously described our technique and results of intragastric resection of GSTs [2-7], and recently we introduced single incision intragastric surgery for GSTs. To accomplish a feasible and safe intragastric approach requires the use of an oral endoscope. Here we report the role of oral endoscope during laparoscopic intragastric surgery of GSTs.

Patients and Methods

During the past 18 years, we have performed laparoscopic intragastric resection of GST for 26 tumors in 20 patients (8 men and 12 women) with a mean age of 61.5 years (range, 34-75 years). The tumor of the stomach was located on the anterior wall of the upper third in 2 patients, the posterior wall of the upper third in 8, the lesser curvature of the upper third in 5, the greater curvature of the upper third in 1, the anterior wall of the middle third in 1, and the posterior wall of the middle third in 1 and the lesser curvature of the middle third in 2, respectively (Table 1). All patients were preoperatively investigated by means of an upper gastrointestinal radiological series and endoscopy with ultrasound to assess the distance between the Esophago Gastric Junction (EGJ) and the proximal side of the tumor and evaluate the size and location of the tumor within the stomach wall layers. Computed tomography with contrast medium was added to clarify whether there were any abdominal findings influencing to the treatment strategy. The indication criteria for this procedure were a tumor locating in the upper and middle stomach or near the esophagogastric junction with an endophytic growth, and a tumor less than 5 cm in diameter and 8 cm2 in cross-section for the specimen removal from the mouth.