Abstract
Background : Natural orifice extraction is now widely performed, but there have been no reports of trans-vaginal specimen extraction (TVSE) following total laparoscopic gastrectomy with laparoscopic and endoscopic cooperative surgery (LECS). We believe this report is the first to describe TVSE+LECS following gastrectomy for gastrointestinal stromal tumor extraction. Methods : The clinical data of two patients with gastrointestinal stromal tumor were reviewed. In LECS, tumor location is confirmed laparoscopically and endoscopically. Blood vessels and other tissues near the tumors are then dissected laparoscopically. Once the tumor area is skeletonized, the endoscopist marks the mucous layer around the tumor with a needle knife. Next IT knife is used to cut through the gastric wall. The rest of the gastric wall around the tumor is dissected with ultrasonic coagulating shears and the tumor is placed in a collection bag. The defect area is generally closed with an intracorporeal continuous suture using absorbable sutures. In TVSE, after a posterior colpotomy is performed, a wound retractor is placed to protect the incision site and maintain the abdominal air pressure. Resected specimens are retrieved via the trans-vaginal route, while the incision in the posterior fornix is closed with a laparoscopic suture. Results : TVSE+LECS following total laparoscopic gastrectomy was successfully accomplished in all patients without intra or postoperative complications. Postoperative pain was particularly mild, which enabled earlier ambulation. Conclusions : The present technique may be a safe and feasible operative procedure for limited groups of elderly female patients with gastrointestinal stromal tumors.
