Laparoscopy-endoscopy Cooperative Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumors
February 19th, 2022
Laparoscopy-endoscopy cooperative surgery is appropriate for the treatment of gastric gastrointestinal stromal tumors less than 5 cm in size. It can achieve the respective advantages of endoscopic and laparoscopic surgeries while avoiding their drawbacks.
After administering general anesthesia, perform gastroscopy on the patient with carbon dioxide insufflation. Next, aspirate the residual gastric fluid and confirm the location of the tumor. After the exploration, completely aspirate the carbon dioxide and fluid in the stomach and the fluid and mucous in the esophagus and throat.
First, confirm the location and boundary of the tumor in the stomach with the help of gastroscopy, if necessary. Then, perform a one-inch abdominal exploration to exclude any other lesions. Dissect the omentum tissue around the mass.
Ensure that the dissection plan is just above the muscle to avoid vagal trunk injury. Resect the mass in block with a five millimeter visual negative margin. After resection, place the specimen in the gastric cavity through the gastric wall defect.
First, perform a full thickness running suture with an absorbable 3-0 Whitlock suture to close the defect in the gastric wall. Then, perform a seromuscular running suture with the same 3-0 Whitlock suture to strengthen the closure. After laparoscopic closure, conduct a leakage test using a combination of laparoscopy and gastroscopy.
Laparoscopically, check if there are any bubbles coming out of the wound after flushing with water. Check if there is wound bleeding, whether the suture is satisfactory and whether the gastric cavity has been deformed by the gastroscopy. Pull the specimen out through the mouth using an endoscopic basket.
After the procedure, check the specimen visually to confirm the margin status. Then, immerse the specimen in a neutral 10%formalin solution. From 2017 to 2020, ten patients with G-GISTs received LECS.
The average age was 49 years. The average tumor size was 2.7 centimeters. The average operation duration time was 112 minutes and the average operative blood loss was eight milliliters.
The average post operating hospital stay was 73 hours. All cases had negative tumor margins, and there were no perioperative complications.
Overview
Laparoscopy-endoscopy cooperative surgery (LECS) is an effective approach for treating gastric gastrointestinal stromal tumors (G-GISTs) smaller than 5 cm. This technique combines the benefits of both endoscopic and laparoscopic surgeries while minimizing their respective drawbacks.
Key Study Components
Area of Science
- Surgical oncology
- Gastroenterology
- Minimally invasive surgery
Background
- G-GISTs are tumors that can be challenging to treat.
- LECS offers a novel surgical option for these tumors.
- Previous methods may have higher complication rates.
- Understanding the effectiveness of LECS is crucial for surgical practices.
Purpose of Study
- To evaluate the safety and efficacy of LECS for G-GISTs.
- To analyze patient outcomes following the procedure.
- To assess the surgical technique's impact on tumor margins.
Methods Used
- General anesthesia was administered to patients.
- Gastroscopy was performed to locate the tumor.
- Abdominal exploration was conducted to assess for other lesions.
- Resection of the tumor was performed with careful margin assessment.
Main Results
- Ten patients underwent LECS with an average tumor size of 2.7 cm.
- All cases achieved negative tumor margins.
- The average operation duration was 112 minutes.
- No perioperative complications were reported.
Conclusions
- LECS is a safe and effective method for treating small G-GISTs.
- The technique minimizes complications while ensuring complete tumor resection.
- Further studies may help refine surgical approaches for G-GISTs.
Frequently Asked Questions
Executive Industry Relevance
Laparoscopy-endoscopy cooperative surgery (LECS) addresses the limitations of standalone endoscopic or laparoscopic approaches for gastric gastrointestinal stromal tumors (G-GISTs) under 5 cm. By integrating real-time endoscopic and laparoscopic visualization, LECS enhances surgical precision, reduces the risk of tumor rupture, and supports complete resection with minimal tissue loss. This hybrid technique enables more predictable outcomes and operational efficiency at a critical inflection point in surgical oncology innovation.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables precise anatomical localization and boundary confirmation for surgical target validation.
- Reduces mechanistic ambiguity by integrating dual-modality visualization during tumor resection.
- Supports functional assessment of resection margins, informing downstream translational research.
Screening & Assay Development
- Facilitates standardized specimen collection with negative margins for molecular and histopathological assays.
- Improves reproducibility of tissue sampling, supporting robust downstream biomarker analysis.
- Enables quantitative assessment of surgical outcomes, such as operative time and blood loss, for procedural benchmarking.
Translational & Preclinical Research
- Provides high-quality, margin-negative tumor specimens for preclinical model development.
- Aligns surgical intervention with translational biomarker strategies by preserving tissue integrity.
- Supports risk-adjusted advancement of surgical techniques into broader clinical research pipelines.
Pipeline & Workflow Integration
LECS is positioned at the interface of surgical innovation and translational research, enabling seamless integration from target validation through specimen-driven discovery and preclinical modeling.
- Discovery Biology: Enhances hypothesis testing by enabling accurate tumor localization and resection margin assessment.
- Screening: Standardizes tissue procurement for downstream molecular and histological analyses.
- Analytics: Provides quantitative outputs such as operative duration, blood loss, and margin status for cross-study comparison.
- Translational Research: Ensures continuity from surgical intervention to preclinical and biomarker studies by preserving specimen quality.
- Enterprise Reuse: Establishes a reproducible surgical workflow adaptable to other minimally invasive oncology applications.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence in surgical margin status and tissue preservation.
- Operational Value: Delivers standardized, reproducible outcomes with reduced perioperative risk and hospital stay.
- Strategic Value: Enables more informed go/no-go decisions for surgical innovation and translational research investments.
- Portfolio Impact: Supports risk-adjusted prioritization of minimally invasive surgical techniques in oncology pipelines.
Implementation Considerations
- Requires multidisciplinary expertise in both endoscopic and laparoscopic techniques.
- Demands access to integrated surgical and endoscopic instrumentation and imaging infrastructure.
- Necessitates cross-team standardization of procedural steps and margin assessment protocols.
- Adaptation may be limited by tumor size, location, and institutional capabilities.
- Specimen handling and margin verification protocols must be rigorously maintained for downstream analyses.
