174 Park JY, et al. gastric wedge resection for SMTs in 10 patients. Materials and Methods Ten patients underwent single-incision laparoscopic gastric wedge resection for gastric SMTs between July 2009 and March 2011 at our institution. The operations were performed by two surgeons experienced in conventional laparoscopic surgery; each surgeon had performed as many as 200 laparoscopic gastric resec- tions before this challenging procedure. The procedure was offered to patients eligible for laparoscopic gastric wedge resection; those who had tumors 2 to 5 cm in size or rapidly increasing during the follow up period, especially if the tumor was located on the ante- rior wall or along the greater curvature of the stomach. Since fine needle aspiration or core needle biopsy is considered to carry a risk of tumor dissemination, it is rarely performed before surgical re- section in our hospital. The medical records of these patients were reviewed retrospectively for demographic data, diagnostic modali- ties, operative procedures, clinicopathological findings, and follow- up. Operating time and specific tumor location in the stomach were also recorded. 1. Surgical technique A 3 to 4 cm-long single vertical incision was made in the um- bilicus, and access to the peritoneal cavity was achieved via an open technique. Then, the two surgeons used different types of platforms to introduce laparoscopic instruments into the abdominal cavity through a single incision. One surgeon used a homemade single-port device composed of a small wound protractor (AlexisⓇ, Applied Medical, Rancho Santa Margarita, CA, USA) and a surgical glove for 4 patients (Fig. 1), and the other used the commercially available OCTO-port (DalimSurgNet, Seoul, Korea) or SILSTM port (Covidien, Mansfield, MA, USA) for the remaining 6 patients. A rigid 10 mm laparoscope of 30 degrees and conventional laparo- scopic instruments with additional articulating instruments were used to optimize the range of motion. Each step in the single-incision laparoscopic procedure was similar to that in the conventional laparoscopic procedure. Tumor location was detected mostly by indirect palpation with laparoscopic instruments, but intraoperative endoscopic assistance was necessary in 2 patients when small endoluminal tumors were not detected by laparoscopic exploration. During the endoscopic procedures, proximal jejunum below the Treiz ligament was gently clamped with laparoscopic instruments to minimize the gas insufflation into the small bowel. After identifying the lesions, the greater omentum and/or short gastric vessels were divided from the greater curvature with ultrasonic coagulating shears, as per requirement. The tumor was elevated by retracting the normal gastric wall near the tumor with a articulating laparoscopic grasper or by pulling the tagging suture on the gastric wall near the tumor. Partial resection of the stomach including the tumor lesion was carried out using multiple endoscopic linear staplers, securing the gross negative margin. Af- ter meticulous hemostasis was achieved along the stapled line, the specimen was placed in a laparoscopic specimen bag and extracted through the umbilicus. Finally, the umbilical wound was closed with an absorbable suture and the umbilicus was restored to its physiological position. Results The mean age at presentation was 54.5 years (range, 44~79), and the patients consisted of 6 men and 4 women. Most patients (80%) were asymptomatic at presentation, with the tumors found incidentally during regular checkups. Other initial symptoms in- cluded regurgitation and dyspepsia. No metastatic disease was ob- served during the initial visit. The diagnostic tools used most often to characterize the tumor before surgery were esophagogastroduodenoscopy (EGD) and computed tomography. All 10 patients underwent both, and 9 out of 10 also underwent additional endoscopic ultrasonography to de- lineate the anatomic layer of the tumor origin. All tumors were de- tected by EGD, and the mean tumor size measured by EGD was 2.5 cm (range, 1.2~5.0 cm). According to the EGD findings, all tumors Fig. 1. Home-made single-port device was made from small wound protractor and a surgical glove with conventional laparoscopic trocars.