Intragastric approach for submucosal tumors located near the Z-line: a hybrid laparoscopic and endoscopic technique.

Shim, Jung Ho; Lee, Han Hong; Yoo, Han Mo; Jeon, Hae Myung; Park, Cho Hyun; Kim, Jun Gi; Song, Kyo Young

BACKGROUND The present study was designed to evaluate the feasibility and impact of the "intragastric" approach to laparoscopic wedge resection as a surgical option for the treatment of suspected small sized gastric submucosal tumors (SMTs) located at the level of Z-line. METHODS We reviewed six patients who underwent laparoscopic intragastric resection of a suspected gastric SMT. In all cases, tumor mass was located just below the Z-line. The patients' clinicopathologic characteristics and surgical outcomes were prospectively recorded and reviewed. RESULTS All six patients were underwent successfully laparoscopic wedge resection by the intragastric approach using a balloon-type trocar. No case was required open conversion. The mean operation time was 128 min, and the mean hospital stay was 4 days. Five cases were proven to have leiomyoma, and one case was found to have gastrointestinal stromal tumor with low risk. The mean tumor size was 2.7 cm. CONCLUSION Laparoscopic resection through the "intragastric" approach is a safe and feasible option for gastric SMTs located at the level of Z-line.