十二指腸GISTに対する腹腔鏡内視鏡合同手術の経験

抄録

In recent years, laparoscopy-endoscopy cooperative surgery (LECS) has been empoloyed as one of the minimally invasive therapies for the treatment of gastric submucosal tumors. In this study, we report a case of LECS applied for the treatment of a duodenal submucosal tumor ; LECS was performed in a 75-year-old man detected to have a submucosal tumor measuring 20 mm in size in the portion of the duodenum contralateral to the ampulla of Vater. Utilizing 5 trocars, we first confirmed the location of the tumor by exposing the second portion of the duodenum. Then the duodenum was mobilized by the Kocher maneuver. A suture anchor was placed on the tumor, followed by duodenal full-thickness incision as in endoscopic submucosal dissection (ESD) . For preventing exposure of the tumor mucosa outside the intestinal lumen, a careful incision was made around the tumor under laparoscopic guidance. After the resection, the duodenum was closed by utilizing the suture technique of gathering the cutting edges vertically to gain a wider lumen. The blood loss was 10 ml, the operative time was 296 minutes, and no intraoperative complications were observed. No postoperative complications, including anastomotic leakage and/or stricture were observed. Histopathology revealed a low-risk gastrointestinal stromal tumor (GIST) and the resection margin was negative. LECS is feasible for the treatment of gastric submucosal tumors, since it preserves gastric function by avoidance of excessive resection and deformation. As long as the indications are carefully selected, especially in respect of the size and location of the tumor, this procedure is also considered to be feasible for the treatment of duodenal submucosal tumors.