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Transumbilical single-incision laparoscopic wedge resection for gastric submucosal tumors: technical challenges encountered in initial experience.

Park JY, Eom BW, Yoon H, Ryu KW, Kim YW, Lee JH - J Gastric Cancer (2012)

Bottom Line: Nine of ten procedures were performed successfully, without the use of additional trocars, or conversion to laparotomy.One patient underwent conversion to multiport laparoscopic surgery, to get simultaneous cholecystectomy safely.This technique provides favorable cosmetic results, and also short hospital stay and low morbidity, in carefully selected candidates.

View Article: PubMed Central - PubMed

Affiliation: Gastric Cancer Branch, National Cancer Center, Goyang, Korea.

ABSTRACT

Purpose: To report the initial clinical experience with single-incision laparoscopic gastric wedge resection for submucosal tumors.

Materials and methods: The medical records of 10 patients who underwent single-incision laparoscopic gastric wedge resection between July 2009 and March 2011 were reviewed retrospectively. The demographic data, clinicopathologic and surgical outcomes were assessed.

Results: The mean tumor size was 2.5 cm (range, 1.2~5.0 cm), and the tumors were mostly located on the anterior wall (4/10) or along the greater curvature (4/10), of the stomach. Nine of ten procedures were performed successfully, without the use of additional trocars, or conversion to laparotomy. One patient underwent conversion to multiport laparoscopic surgery, to get simultaneous cholecystectomy safely. The mean operating time was 66.5 minutes (range, 24~132 minutes), and the mean postoperative hospital stay was 5 days (range, 4~7 days). No serious perioperative complications were observed. Of the 10 submucosal tumors, the final pathologic report revealed 5 gastrointestinal stromal tumors, 4 schwannomas, and 1 heterotopic pancreas.

Conclusions: Single-incision laparoscopic gastric wedge resection for gastric submucosal tumors is feasible and safe, when performed by experienced laparoscopic surgeons. This technique provides favorable cosmetic results, and also short hospital stay and low morbidity, in carefully selected candidates.

No MeSH data available.


Related in: MedlinePlus

Operating time and tumor characteristics. The operating time varied according to tumor size and location, but generally tended to decline with the accumulation of the surgeon's experience. HPF = high power field; LB = lower body; MB = mid-body; GC = greater curvature; AW = anterior wall; PW = posterior wall; exo = exophytic; endo = endoluminal.
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Figure 2: Operating time and tumor characteristics. The operating time varied according to tumor size and location, but generally tended to decline with the accumulation of the surgeon's experience. HPF = high power field; LB = lower body; MB = mid-body; GC = greater curvature; AW = anterior wall; PW = posterior wall; exo = exophytic; endo = endoluminal.

Mentions: Single-incision laparoscopic gastric wedge resection was successfully completed in 9 patients without conversion to conventional laparoscopic surgery. In 1 patient, moderate hemorrhagic event occurred during cholelcystectomy after the successful gastric resection, and 2 additional trocars were needed to safely perform simultaneous cholecystectomy for comorbid gall bladder stones. All tumors were resected via an extraluminal approach. The mean operating time was 66.5 minutes (range, 24~132 minutes). The operating time varied a lot according to the tumor size and location (Fig. 2). The estimated blood loss during the operation was minimal in all patients. The mean postoperative hospital stay was 5 days (range, 4~7 days). The postoperative course was uneventful, with no postoperative complications in the follow-up period. The final pathology confirmed 5 gastrointestinal stromal tumors, 4 schwannomas, and 1 heterotopic pancreas. Eight specimens showed ≤5 mitoses in 50 high-power fields, although 1 case showed 11 mitoses per 50 high-power fields. The mean distance from the tumor to the resection margin was 0.4 cm (range, 0.1~1.5 cm). Nine patients were followed regularly, and the mean follow-up duration was 13 months (range, 2~25 months), during which time no recurrence or metastases were observed (Table 1). The mean follow-up duration for 5 gastrointestinal stromal tumor (GIST) patients was 15 months (range, 12~25 months).


Transumbilical single-incision laparoscopic wedge resection for gastric submucosal tumors: technical challenges encountered in initial experience.

Park JY, Eom BW, Yoon H, Ryu KW, Kim YW, Lee JH - J Gastric Cancer (2012)

Operating time and tumor characteristics. The operating time varied according to tumor size and location, but generally tended to decline with the accumulation of the surgeon's experience. HPF = high power field; LB = lower body; MB = mid-body; GC = greater curvature; AW = anterior wall; PW = posterior wall; exo = exophytic; endo = endoluminal.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3473224&req=5

Figure 2: Operating time and tumor characteristics. The operating time varied according to tumor size and location, but generally tended to decline with the accumulation of the surgeon's experience. HPF = high power field; LB = lower body; MB = mid-body; GC = greater curvature; AW = anterior wall; PW = posterior wall; exo = exophytic; endo = endoluminal.
Mentions: Single-incision laparoscopic gastric wedge resection was successfully completed in 9 patients without conversion to conventional laparoscopic surgery. In 1 patient, moderate hemorrhagic event occurred during cholelcystectomy after the successful gastric resection, and 2 additional trocars were needed to safely perform simultaneous cholecystectomy for comorbid gall bladder stones. All tumors were resected via an extraluminal approach. The mean operating time was 66.5 minutes (range, 24~132 minutes). The operating time varied a lot according to the tumor size and location (Fig. 2). The estimated blood loss during the operation was minimal in all patients. The mean postoperative hospital stay was 5 days (range, 4~7 days). The postoperative course was uneventful, with no postoperative complications in the follow-up period. The final pathology confirmed 5 gastrointestinal stromal tumors, 4 schwannomas, and 1 heterotopic pancreas. Eight specimens showed ≤5 mitoses in 50 high-power fields, although 1 case showed 11 mitoses per 50 high-power fields. The mean distance from the tumor to the resection margin was 0.4 cm (range, 0.1~1.5 cm). Nine patients were followed regularly, and the mean follow-up duration was 13 months (range, 2~25 months), during which time no recurrence or metastases were observed (Table 1). The mean follow-up duration for 5 gastrointestinal stromal tumor (GIST) patients was 15 months (range, 12~25 months).

Bottom Line: Nine of ten procedures were performed successfully, without the use of additional trocars, or conversion to laparotomy.One patient underwent conversion to multiport laparoscopic surgery, to get simultaneous cholecystectomy safely.This technique provides favorable cosmetic results, and also short hospital stay and low morbidity, in carefully selected candidates.

View Article: PubMed Central - PubMed

Affiliation: Gastric Cancer Branch, National Cancer Center, Goyang, Korea.

ABSTRACT

Purpose: To report the initial clinical experience with single-incision laparoscopic gastric wedge resection for submucosal tumors.

Materials and methods: The medical records of 10 patients who underwent single-incision laparoscopic gastric wedge resection between July 2009 and March 2011 were reviewed retrospectively. The demographic data, clinicopathologic and surgical outcomes were assessed.

Results: The mean tumor size was 2.5 cm (range, 1.2~5.0 cm), and the tumors were mostly located on the anterior wall (4/10) or along the greater curvature (4/10), of the stomach. Nine of ten procedures were performed successfully, without the use of additional trocars, or conversion to laparotomy. One patient underwent conversion to multiport laparoscopic surgery, to get simultaneous cholecystectomy safely. The mean operating time was 66.5 minutes (range, 24~132 minutes), and the mean postoperative hospital stay was 5 days (range, 4~7 days). No serious perioperative complications were observed. Of the 10 submucosal tumors, the final pathologic report revealed 5 gastrointestinal stromal tumors, 4 schwannomas, and 1 heterotopic pancreas.

Conclusions: Single-incision laparoscopic gastric wedge resection for gastric submucosal tumors is feasible and safe, when performed by experienced laparoscopic surgeons. This technique provides favorable cosmetic results, and also short hospital stay and low morbidity, in carefully selected candidates.

No MeSH data available.


Related in: MedlinePlus