J Gastric Cancer 2012;12(3):173-178  http://dx.doi.org/10.5230/jgc.2012.12.3.173 Original Article Transumbilical Single-Incision Laparoscopic Wedge Resection for Gastric Submucosal Tumors: Technical Challenges Encountered in Initial Experience Ji Yeon Park, Bang Wool Eom, Hongman Yoon, Keun Won Ryu, Young-Woo Kim, and Jun Ho Lee Gastric Cancer Branch, National Cancer Center, Goyang, Korea Purpose: To report the initial clinical experience with single-incision laparoscopic gastric wedge resection for submucosal tumors. Materials and Methods: The medical records of 10 patients who underwent single-incision laparoscopic gastric wedge resection be- tween July 2009 and March 2011 were reviewed retrospectively. The demographic data, clinicopathologic and surgical outcomes were assessed. Results: The mean tumor size was 2.5 cm (range, 1.2~5.0 cm), and the tumors were mostly located on the anterior wall (4/10) or along the greater curvature (4/10), of the stomach. Nine of ten procedures were performed successfully, without the use of additional trocars, or conversion to laparotomy. One patient underwent conversion to multiport laparoscopic surgery, to get simultaneous cholecys- tectomy safely. The mean operating time was 66.5 minutes (range, 24~132 minutes), and the mean postoperative hospital stay was 5 days (range, 4~7 days). No serious perioperative complications were observed. Of the 10 submucosal tumors, the final pathologic report revealed 5 gastrointestinal stromal tumors, 4 schwannomas, and 1 heterotopic pancreas. Conclusions: Single-incision laparoscopic gastric wedge resection for gastric submucosal tumors is feasible and safe, when performed by experienced laparoscopic surgeons. This technique provides favorable cosmetic results, and also short hospital stay and low morbidity, in carefully selected candidates. Key Words: Stomach neoplasms; Gastrointestinal stromal tumors; Gastrectomy; Surgical procedures, minimally invasive Introduction results. Recently, two revolutionary techniques were developed: natural orifice transluminal endoscopic surgery (NOTES),(1-4) in Laparoscopic surgery is a well-established alternative to open which transabdominal incisions are completely avoided, and single- surgery in various abdominal conditions. In general, the benefits of incision laparoscopic surgery (SILS),(5-9) in which laparoscopic laparoscopy in terms of postoperative pain, recovery, and cosmetic procedures are performed through a single umbilical incision. results are widely recognized. NOTES may be the final frontier of minimally invasive surgery; Many surgeons have attempted to reduce the invasiveness of however, it requires a transition from laparoscopic surgical skills to traditional laparoscopic surgery and to achieve better cosmetic endoscopic surgical skills and further development of incomplete Correspondence to: Jun Ho Lee Gastric Cancer Branch, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang 410-769, Korea Tel: +82-31-920-1629, Fax: +82-31-920-0069 E-mail: kosmas@ncc.re.kr Received June 3, 2012 Revised July 24, 2012 Accepted July 25, 2012 technology. As a bridge between NOTES and traditional laparo- scopic surgery, SILS came into the spotlight because it minimizes invasiveness by reducing the number of incisions, thereby also re- ducing the degree of postoperative pain.(10) Our institution began performing SILS for gastric submucosal tumors (SMTs) in July 2009, and we report the technical pitfalls and results of our initial experience of single-incision laparoscopic This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/3.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyrights © 2012 by The Korean Gastric Cancer Association www.jgc-online.org