The laparoscopic approach is widely accepted surgical treatment for gastrointestinal submucosal tumors (SMTs). In this chapter, we will introduce laparoscopic techniques and strategy for gastrointestinal SMTs, in accordance with those for gastrointestinal stromal tumors (GISTs). The indication for a laparoscopic approach has been related to tumor size. The upper limit of tumor size has increased, according to recent trends, and there is no established guideline for a lower limit. All patients undergoing laparoscopic surgery receive preoperative examinations including gastrofiberscopy, upper gastrointestinal radiography, computed tomography (CT), and endoscopic ultrasonography (EUS). Gastric tumors <20 mm in diameter measured by EUS or CT are preoperatively localized by gastrofiberscopic clipping of the mucosa covering the SMT. While maintaining the principle of local resection with a negative resection margin, different surgical techniques are required depending on the location and configuration of the tumor. A single dose of a second-generation cephalosporin is administered to patients as a prophylactic antibiotic before or immediately after operation. If a patient undergoes wedge resection, a semi-bland diet will be provided within 48-72 hours. However, in cases of proximal or distal gastrectomy, the diet will be restricted for several days. A "no-touch" technique, by which the risk of tumor dissemination can be minimized, includes grasping the surrounding tissues, holding the threads sutured at the normal serosa around the tumor, and using a laparoscopic stapler or bag during laparoscopic resection.
Keywords: Laparoscopic; gastrointestinal stromal tumor (GIST); submucosal tumor (SMT).
Conflict of interest statement
Conflicts of Interest: The authors have no conflicts of interest to declare.
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Laparoscopic Resection for Gastrointestinal Stromal Tumors in the StomachY Kakeji et al. Surg Today 42 (6), 554-8. PMID 22124810.Endoscopic ultrasound-guided FNAB is recommended for definite preoperative diagnosis of histopathologically unknown SMTs to determine the indications for surgery. The lap …
Feasibility of Endoscopic Submucosal Dissection for Upper Gastrointestinal Submucosal Tumors Treatment and Value of Endoscopic Ultrasonography in Pre-Operation Assess and Post-Operation Follow-Up: A Prospective Study of 224 Cases in a Single Medical CenterG He et al. Surg Endosc 30 (10), 4206-13. PMID 26823060.The predominant SMTs in upper gastrointestinal tract were leiomyoma in esophageal tumors which originated from muscularis mucosae and GIST in stomach which originated fro …
Diagnostic and Treatment Strategy for Small Gastrointestinal Stromal TumorsT Nishida et al. Cancer 122 (20), 3110-3118. PMID 27478963. - ReviewGastrointestinal stromal tumors (GISTs) are considered to be potentially malignant mesenchymal tumors of the gastrointestinal tract. Clinically relevant GISTs are rare; h …
Submucosal Tumors: Comprehensive Guide for the Diagnosis and Therapy of Gastrointestinal Submucosal TumorsT Nishida et al. Dig Endosc 25 (5), 479-89. PMID 23902569. - ReviewSmall submucosal tumors (SMT) without symptoms are frequently found by endoscopic and radiological examinations. To find proper diagnostic measures and therapeutic indica …
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Comparison of Safety and Outcomes Between Endoscopic and Surgical Resections of Small (≤ 5 Cm) Primary Gastric Gastrointestinal Stromal TumorsT Pang et al. J Cancer 10 (17), 4132-4141. PMID 31417658.Endoscopic resection of selected small gastric GISTs (≤ 5cm) was feasible, safe, and associated with better intraoperative results and an equal postoperative course, comp …
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Laparoscopic Techniques and Strategies for Gastrointestinal GISTsCM Lee et al. J Vis Surg 3, 62. PMID 29078625. - ReviewThe laparoscopic approach is widely accepted surgical treatment for gastrointestinal submucosal tumors (SMTs). In this chapter, we will introduce laparoscopic techniques …