Laparoscopic Submucosal Dissection for Gastrointestinal Stromal Tumor of the Stomach: A Novel Technique for Local Excision with a Minimal Curative Margin

Abstract

Background: Laparoscopic wedge resection is accepted as a curative treatment for small- and mediumsized gastroin-testinal stromal tumors (GISTs) of the stomach. Conventional methods involving surgical staplers require relatively large lateral margins, which may cause deformity and postoperative dysfunction of the gastric remnant. In this study, we introduce a novel technique called laparoscopic submucosal dissection (LSD) in which the defects of the stomach are minimized and a microscopic negative margin is secured. Methods: The normal seromuscular layer of the gastric wall was dissected with a 5 mm lateral margin. Then, the submucosal tissue was divided carefully using a monopolar electrosurgical device with a curved spatula tip. Results: The operation time was 170 min, and the amount of bleeding was very small. We confirmed an intact pseudo-capsule and marginal subserosal or submucosal tissue of the tumor by histological analysis. The postoperative course was uneventful with no complications. Endoscopy showed minimal deformity of the gastric remnant. Conclusions: We think that LSD is a curative and less invasive treatment for GIST of the stomach. Further investigations are necessary to evaluate the oncological and functional outcomes of this procedure.