Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Oct 10, 2015; 7(14): 1150-1156
Published online Oct 10, 2015. doi: 10.4253/wjge.v7.i14.1150
Laparoscopic endoscopic cooperative surgery as a minimally invasive treatment for gastric submucosal tumor
Tsutomu Namikawa, Kazuhiro Hanazaki
Tsutomu Namikawa, Kazuhiro Hanazaki, Department of Surgery, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
Author contributions: Namikawa T drafted the manuscript, prepared the figures and tables; Hanazaki K made critical revisions.
Institutional review board statement: This study was considered exempt by the Kochi Medical School Institutional Review Board.
Informed consent statement: Informed consent was obtained from the patients for publication in this case report.
Conflict-of-interest statement: We declare that there is no conflict of interest associated with any of the authors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tsutomu Namikawa, MD, PhD, Department of Surgery, Kochi Medical School, Kohasu, Okocho, Nankoku, Kochi 783-8505, Japan. tsutomun@kochi-u.ac.jp
Telephone: +81-88-8802370 Fax: +81-88-8802371
Received: June 30, 2015
Peer-review started: July 4, 2015
First decision: July 29, 2015
Revised: August 5, 2015
Accepted: September 7, 2015
Article in press: September 8, 2015
Published online: October 10, 2015
Processing time: 110 Days and 14.5 Hours
Abstract

Laparoscopic wedge resection is a useful procedure for treating patients with submucosal tumor (SMT) including gastrointestinal stromal tumor (GIST) of the stomach. However, resection of intragastric-type SMTs can be problematic due to the difficulty in accurately judging the location of endoluminal tumor growth, and often excessive amounts of healthy mucosa are removed; thus, full-thickness local excision using laparoscopic and endoscopic cooperative surgery (LECS) is a promising procedure for these cases. Our experience with LECS has confirmed this procedure to be a safe, feasible, and minimally invasive treatment method for gastric GISTs less than 5 cm in diameter, with outcomes similar to conventional laparoscopic wedge resection. The important advantage of LECS is the reduction in the resected area of the gastric wall compared to that in conventional laparoscopic wedge resection using a linear stapler. Early gastric cancer fits the criteria for endoscopic resection; however, if performing endoscopic submucosal dissection is difficult, the LECS procedure might be a good alternative. In the future, LECS is also likely to be indicated for duodenal tumors, as well as gastric tumors. Furthermore, developments in endoscopic and laparoscopic technology have generated various modified LECS techniques, leading to even less invasive surgery.

Keywords: Cooperative surgery; Endoscopy; Gastrointestinal tumor; Laparoscopy; Submucosal tumor

Core tip: Resection of intragastric-type submucosal tumor can be problematic due to the difficulty in accurately judging the location of endoluminal tumor growth, and often excessive amounts of healthy mucosa are removed; thus, full-thickness local excision using laparoscopic and endoscopic cooperative surgery (LECS) is a promising procedure for these cases. The important advantage of LECS is the reduction in the resected area of the gastric wall compared to that in conventional laparoscopic wedge resection using a linear stapler. Developments in endoscopic and laparoscopic technology have generated various modified LECS techniques, leading to even less invasive surgery.