The Role of Oral Endoscope during Laparoscopic Intragastric Surgery of Gastric Submucosal Tumor

Introduction: Recently the surgical resection of Gastric Submucosal Tumor (GST) has been adapted to laparoscopic approaches. The use of an oral endoscope is required to accomplish a feasible and safe intragastric approach. Here we report the role of oral endoscope during laparoscopic intragastric surgery of GSTs. Patients and Methods: We performed laparoscopic intragastric resection of GSTs in 20 patients. We selected two approaches; 1) Two or three ports were directly inserted into the stomach, or 2) The stomach was directly opened through a 2.5-cm single skin incision at umbilicus. Both approaches were completed under the guidance of oral endoscope. Results: Laparoscopic intragastric resection was successful in all patients. The mean maximum tumor diameter, operation time and blood loss were 27.1 mm 155 min and 14ml, respectively. One patient required a gastrostomy to remove the tumor. There was one postoperative bleeding. The mean postoperative hospital stay was 7.7 days. There were no recurrences during a mean follow-up period of 97.4 months. The use of an oral endoscope lead a determination of the port placement in the stomach, a visual supplement of laparoscopic intragastric resection, a retrieval of the specimen via the mouth, and a final check of the presence of air leakage or bleeding from after re-inflation of the stomach. Conclusion: Intragastric surgery using oral endoscopy can be considerably beneficial for patients with GSTs located in the upper and middle part of the stomach. The significance of oral endoscopy during laparoscopic procedures was emphasized from the viewpoint of minimal surgical invasiveness.