MODIFICATIONS OF THE PROCEDURE AND INDICATION OF LAPAROSCOPIC SURGERY FOR SUBMUCOSAL GASTRIC TUMORS

We evaluated 16 resected cases of submucosal gastric tumor in which laparoscopic techniques were used. The tumors were located in the upper, middle, and lower third of the stomach in 9, 5, and 2 cases, respectively. Three tumors were located mainly on the anterior and 5 were on the posterior gastric wall, and 7 were on the lesser and 1 was on the greater curvature. The resected tumor sizes averaged 2.8×2.1cm. Twelve tumors were intraluminal and 4 were extraluminal type according to the classification of growth type. A histopathological examination identified 10 leiomyomas, 2 leiomyosarcomas and 4 smooth muscle tumors of indeterminate malignant potential. An intraluminal tumor was found to be more complicated to resect laparoscopically without companion methods due to the difficulty in detection and resection from the serosal side compared with an extraluminal tumor (operating time: 225.5min vs 172.7min, respectively). Therefore, we attempted to resect an intraluminal tumor with ink-marking by intraoperative endoscopy and to resect as small a size as possible. These modifications were successful in reducing operating efforts.