176 Park JY, et al. tially malignant. Although endoscopy can accurately identify these lesions, it is difficult to arrive at a preoperative histological diagnosis through routine intraluminal endoscopic biopsy. Preoperative fine- needle aspiration biopsy and core needle biopsy under endoscopic ultrasonographic guidance might be useful diagnostic tools, but are not applicable in all cases and can also lead to tumor cell dis- semination.(11) Furthermore, even with needle biopsy specimen, it remains difficult to predict whether the tumor poses malignant po- tential to metastasize to distant organs.(12) Thus, without clear evi- dence of benign features, SMTs should be considered GISTs, which accounts for the majority of gastric SMTs, and should be resected to arrive at a definite pathological diagnosis and ensure removal of the lesion. In recent years, laparoscopic wedge resection has been regarded as safe and technically feasible with favorable oncologic outcomes when performed by skilled surgeons.(11,13-16) Generally accepted indications for laparoscopic management of gastric SMTs include tumors between 2 and 5 cm in diameter, rapid increase in tumor size during endoscopic surveillance, and presence of symptoms. Incidentally discovered SMTs less than 2 cm in diameter are usu- ally followed up by endoscopy or computed tomography every 6 months to 12 months. For patients with rapidly growing tumors suspected to possess malignant potential, surgical resection is strongly recommended regardless of tumor size.(11,14,16-18) Of the patients for whom laparoscopic wedge resection is indicated, those who have suitable tumor locations and characteristics can undergo a SILS approach. The perioperative results in our patients were thought to be comparable to those in the previously reported laparoscopic series. (15,16) The cosmetic outcomes after SILS were excellent as the only single incision made stayed hidden inside the umbilicus (Fig. 3). Generally, the length of postoperative hospital stay is considered as a parameter of invasiveness of surgery.(19) The mean hospital stay after SILS gastric wedge resection was 5 days, which is acceptable and even shorter than that seen after conventional laparoscopic surgery. These results suggest that SILS procedure can provide pa- tients with the following benefits: better cosmesis, less postoperative pain, fewer postoperative morbidities, and shorter convalescence. This also satisfies a growing demand for less-invasive surgical procedures. Moreover, SILS can be performed with conventional laparoscopic instruments and skills, with little modification. The most challenging point in SILS as well as conventional laparoscopic surgery is confirming the precise location of intralu- minal tumors and determining the appropriate resection line. Be- cause excessive resection may result in deformity of the stomach, and consequent gastric stasis, detecting the precise location of the tumor during surgery is crucial. Several methods have been used to demarcate the tumor, such as laparoscopic ultrasonography, endoscopic intraluminal marking with dye, diaphanoscopy, and magnetic marking clips,(20,21) but all these methods are cumber- some, often expensive and still do not elucidate the exact location of the tumor. Recent reports have described various combined laparoscopic and endoscopic surgical techniques involving the si- multaneous use of two procedures.(22,23) Although they showed some promising results, all these methods were used and evaluated in conventional multiport laparoscopic surgeries. The use of these methods is expected to be far more challenging during single- incision surgery and needs further evaluation to be generalized in clinical practice. In addition, SILS has some technical challenges. Insertion of several instruments, along with the laparoscope, into the abdomi- nal cavity through a single incision markedly decreases the range of motion and results in conflict between instruments. This con- flict makes surgical dissection much more difficult compared to conventional multiport laparoscopic surgery. It is also difficult to keep an ideal view due to consistent clash of camera with operat- ing instruments, so that expert camera operator experienced in handling flexible or 30 degree laparoscope is essential. The use of articulating instruments (laparoscopic graspers, shears, and sta- plers) could improve the performance with less interference, and the recently introduced pre-bent instruments further facilitate the Fig. 3. Photograph of the abdomen taken 1 month after the operation shows excellent cosmesis with minimal scar.