CASE REPORT Single-port laparoscopic and endoscopic cooperative surgery for a gastric gastrointestinal stromal tumor: report of a case Toru Obuchi • Akira Sasaki • Shigeaki Baba • Hiroyuki Nitta • Koki Otsuka • Go Wakabayashi Received: 10 July 2013 / Accepted: 23 January 2014 Ó Springer Japan 2014 Abstract We herein report a case of single-port laparo- scopic and endoscopic cooperative surgery (LECS) for a gastric gastrointestinal stromal tumor (GIST). A 75-year-old female with an endoluminal GIST located near the esophag- ogastric junction underwent LECS. Both the mucosal and submucosal layers around the tumor were circumferentially dissected using endoscopic submucosal dissection via intra- luminal endoscopy. The endoluminal GIST was exteriorized to the abdominal cavity. The tumor and the edge of the inci- sion line were closed using an endoscopic linear stapler. The LECS was successfully accomplished without the need for any skin incisions or additional ports. The length of the operation was 120 min and blood loss was 5 ml. Oral intake was resumed on the second day and the length of hospital stay was 5 days. No complications were noted and the patient had an excellent cosmetic result. In our experience, single-port LECS is feasible and safe for gastric GIST when performed by a surgeon experienced in laparoscopic and gastric surgery. Keywords Laparoscopic and endoscopic cooperative surgery (LECS) Á Gastrointestinal stromal tumor Á Laparoscopic gastric resection Á Single-port surgery Á Single-incision surgery Introduction Local gastric resection has become the standard procedure of choice for treating patients with a gastric gastrointestinal stromal tumor (GIST) [1–4]. As GISTs rarely involve lymph nodes, and because they require resection with gross negative margins only, they are suitable for a laparoscopic approach [2]. Lately, the increasing interest in minimally invasive surgery has led to the development of single-port laparoscopic surgery (SPLS), which is also known as single-incision laparoscopic surgery. SPLS minimizes the abdominal trauma and has potential benefits over conventional multiport laparoscopic surgery, including decreased incisional pain and improved cosmesis [5–7]. However, single-port laparoscopic resection (SPLR) for the treatment of gastric GISTs has only been described in limited and small case studies [7–9]. In our insti- tution, SPLR for gastric GISTs has been performed since 2009 [4, 8], and the use of the single-port approach has since been extended to include lesions located almost anywhere in the stomach. Laparoscopic exogastric wedge resection, using an endoscopic linear stapler, is now the gold standard technique used for treating gastric GISTs. SPLR, as well as conventional multiport laparoscopic resection (MPLR) using an exogastric approach, is not suitable for the treatment of endoluminal tumors located near the esophagogastric junction (EGJ) or pyloric ring. These tumors are often difficult to treat using a conventional exogastric approach. This is because of the diffi- culties associated with removing the excess mucosa upon resecting a tumor with endoluminal growth, which sometimes leads to postoperative deformity of the stomach. Laparoscopic and endoscopic cooperative surgery (LECS) is a recently developed procedure that enables a tumor to be resected with minimum surgical margins. In this paper, we describe our initial experience employing single-port LECS for a gastric GIST. Case report A 75-year-old female underwent a general health check in 2005, and a 1.4-cm gastric submucosal tumor (SMT) T. Obuchi (&) Á A. Sasaki Á S. Baba Á H. Nitta Á K. Otsuka Á G. Wakabayashi Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka 020-8505, Japan e-mail: tobuchi@iwate-med.ac.jp 123 Surg Today DOI 10.1007/s00595-014-0870-z