Reduced-port surgery with the cowboy technique for a gastric submucosal tumor.

Tsuboi, Kazuto; Yano, Fumiaki; Omura, Nobuo; Misawa, Takeyuki; Kashiwagi, Hideyuki

INTRODUCTION Laparoscopic surgery is considered safe and effective for a gastric submucosal tumors, and reduced-port surgery (RPS) is being increasingly performed to treat these tumors. Herein, we present laparoscopic RPS with the cowboy technique for the removal of gastric submucosal tumors. MATERIALS AND SURGICAL TECHNIQUE A single-port access device was inserted at the naval (three 5-mm trocars), and a 5-mm trocar was inserted in the left lateral abdominal wall. A ligature was placed at the neck of the tumor, the loop was then tightened, and the knot was finally secured-a process referred to as the cowboy technique. This technique enables complete surgical excision and can be used for exophytic submucosal tumors of the stomach. Four patients underwent RPS with this technique, and the outcomes were good. DISCUSSION Our cowboy technique enables the safe full-thickness excision of gastric submucosal tumors with exophytic growth and is very useful in performing RPS.