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.
