Surgical Endoscopy

, Volume 22, Issue 7, pp 1729–1735 | Cite as

Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection

  • N. HikiEmail author
  • Y. Yamamoto
  • T. Fukunaga
  • T. Yamaguchi
  • S. Nunobe
  • M. Tokunaga
  • A. Miki
  • S. Ohyama
  • Y. Seto



Laparoscopic wedge resections are increasingly applied for gastric submucosal tumors such as gastrointestinal stromal tumor (GIST). Despite this, no defined strategy exists to guide the surgeon in choosing the appropriate laparoscopic technique for an individual case on the basis of tumor characteristics such as location or size. This study aimed to introduce a laparoscopic and endoscopic cooperative surgery (LECS) for gastric wedge resection that is applicable for submucosal tumor resection independent of tumor location and size.


Seven patients underwent LECS for the resection of gastric submucosal tumors. Both mucosal and submucosal layers around the tumor were circumferentially dissected using endoscopic submucosal dissection via intraluminal endoscopy. Subsequently, the seromusclar layer was laparoscopically dissected on the exact three-fourths cut line around the tumor. The submucosal tumor then was exteriorized to the abdominal cavity and dissected with a standard endoscopic stapling device.


In all cases, the LECS procedure was successful for dissecting out the gastric submucosal tumor. In four of seven cases, the tumor was located in the upper gastric portion near the esophagogastric junction. The remaining three tumors were in the posterior gastric wall. In two cases, the tumors were more than 5 cm in diameter, and one was a GIST of the remnant stomach. The mean operation time was 169 ± 17 min, and the estimated blood loss was 7 ± 2 ml. The postoperative course was uneventful in all cases.


The LECS procedure for dissection of gastric submucosal tumors such as GIST may be performed safely with reasonable operation times, less bleeding, and adequate cut lines. In addition, the success of the procedure does not depend on the tumor location such as the vicinity of the esophagogastric junction or pyloric ring.


Endoscopy Gastrointestinal stromal tumor GIST Laparoscopy Endoscopic submucosal dissection (ESD) 



All artwork was drawn by special medical illustrator Mr. Leon Sakuma. We are deeply indebted to Ms. Noriko Okita for English correction of the text.


  1. 1.
    Ohgami M, Otani Y, Kumai K, Kubota T, Kim YI, Kitajima M (1999) Curative laparoscopic surgery for early gastric cancer: five years experience. World J Surg 23:187–192PubMedCrossRefGoogle Scholar
  2. 2.
    Choi SM, Kim MC, Jung GJ, Kim HH, Kwon HC, Choi SR, Jang JS, Jeong JS (2006) Laparoscopic wedge resection for gastric GIST: long-term follow-up results. Eur J Surg Oncol 33:444–447PubMedCrossRefGoogle Scholar
  3. 3.
    Granger SR, Rollins MD, Mulvihill SJ, Glasgow RE (2006) Lessons learned from laparoscopic treatment of gastric and gastroesophageal junction stromal cell tumors. Surg Endosc 20:1299–1304PubMedCrossRefGoogle Scholar
  4. 4.
    Yano H, Kimura Y, Iwazawa T, Takemoto H, Imasato M, Monden T, Okamoto S (2005) Hand-assisted laparoscopic surgery for a large gastrointestinal stromal tumor of the stomach. Gastric Cancer 8:186–192PubMedCrossRefGoogle Scholar
  5. 5.
    Hyung WJ, Lim JS, Cheong JH, Kim J, Choi SH, Noh SH (2005) Laparoscopic resection of a huge intraluminal gastric submucosal tumor located in the anterior wall: eversion method. J Surg Oncol 89:95–98PubMedCrossRefGoogle Scholar
  6. 6.
    Lee JH, Han HS, Kim YW, Min SK, Lee HK (2003) Laparoscopic wedge resection with handsewn closure for gastroduodenal tumors. J Laparoendosc Adv Surg Tech A 13:349–353PubMedCrossRefGoogle Scholar
  7. 7.
    Ludwig K, Wilhelm L, Scharlau U, Amtsberg G, Bernhardt J (2002) Laparoscopic-endoscopic rendezvous resection of gastric tumors. Surg Endosc 16:1561–1565PubMedCrossRefGoogle Scholar
  8. 8.
    Ridwelski K, Pross M, Schubert S, Wolff S, Gunther T, Kahl S, Lippert H (2002) Combined endoscopic intragastral resection of a posterior stromal gastric tumor using an original technique. Surg Endosc 16:537PubMedCrossRefGoogle Scholar
  9. 9.
    Nguyen NT, Jim J, Nguyen A, Lee J, Chang K (2003) Laparoscopic resection of gastric stromal tumor: a tailored approach. Am Surg 69:946–950PubMedGoogle Scholar
  10. 10.
    Avital S, Brasesco O, Szomstein S, Liberman M, Rosenthal R (2003) Technical considerations in laparoscopic resection of gastric neoplasms. Surg Endosc 17:763–765PubMedCrossRefGoogle Scholar
  11. 11.
    Gotoda T (2005) A large endoscopic resection by endoscopic submucosal dissection procedure for early gastric cancer. Clin Gastroenterol Hepatol 3:S71–S73PubMedCrossRefGoogle Scholar
  12. 12.
    Fujishiro M, Yahagi N, Nakamura M, Kakushima N, Kodashima S, Ono S, Kobayashi K, Hashimoto T, Yamamichi N, Tateishi A, Shimizu Y, Oka M, Ogura K, Kawabe T, Ichinose M, Omata M (2006) Successful outcomes of a novel endoscopic treatment for GI tumors: endoscopic submucosal dissection with a mixture of high-molecular-weight hyaluronic acid, glycerin, and sugar. Gastrointest Endosc 63:243–249PubMedCrossRefGoogle Scholar
  13. 13.
    Lee IL, Lin PY, Tung SY, Shen CH, Wei KL, Wu CS (2006) Endoscopic submucosal dissection for the treatment of intraluminal gastric subepithelial tumors originating from the muscularis propria layer. Endoscopy 38:1024–1028PubMedCrossRefGoogle Scholar
  14. 14.
    Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229PubMedCrossRefGoogle Scholar
  15. 15.
    Kitano S, Shiraishi N (2005) Minimally invasive surgery for gastric tumors. Surg Clin North Am 85:151–64, xiPubMedCrossRefGoogle Scholar
  16. 16.
    DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF (2000) Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 231:51–58PubMedCrossRefGoogle Scholar
  17. 17.
    Joensuu H, Fletcher C, Dimitrijevic S, Silberman S, Roberts P, Demetri G (2002) Management of malignant gastrointestinal stromal tumours. Lancet Oncol 3:655–664PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • N. Hiki
    • 1
    Email author
  • Y. Yamamoto
    • 2
  • T. Fukunaga
    • 1
  • T. Yamaguchi
    • 1
  • S. Nunobe
    • 1
  • M. Tokunaga
    • 1
  • A. Miki
    • 1
  • S. Ohyama
    • 1
  • Y. Seto
    • 1
  1. 1.Department of Gastroenterological Surgery, Gastroenterological CenterCancer Institute Hospital, Japanese Foundation for Cancer ResearchTokyoJapan
  2. 2.Department of Gastroenterological Endoscopy, Gastroenterological CenterCancer Institute Hospital, Japanese Foundation for Cancer ResearchTokyoJapan

Personalised recommendations