[A Case of Combined Single Incisional Laparoscopic and Endoscopic Approaches to Neoplasia with Non-Exposure Technique(CLEAN-NET)for Gastric GIST].

An 80-year-old female patient visited our hospital with scrutinizing acid reflex after meals. Esophagogastroendoscopy (EGD)and computed tomography(CT)showed a 25 mm submucosal tumor of the stomach in the lesser curvature of the middle stomach. A pathological examination using endoscopic ultrasound-guided fine needle aspiration(EUS-FNA) revealed gastrointestinal stromal tumor(GIST). The combination of laparoscopic and endoscopic approaches to neoplasia with the non-exposure technique(CLEAN-NET)was undertaken via a 2.5 cm single umbilical incision. The tumor was identified by EGD, and the scheduled dissected line was confirmed both from the mucosal and serosa side with an endoscope and laparoscope, respectively. The serosal and muscular layers were incised with an electric knife from outside the gastric wall; hypertonic saline solution was locally injected to swell the submucosal layer; partial gastric resection was performed with an automatic suture device without capsule damage. The operation time was 61 minutes, and there was blood less. The patient was discharged 6 days after the operation without complications. Histopathological findings showed GIST, 16× 14 mm, c-kit(+), CD34(+). The tumor was very low risk, as per the modified-Fletcher classification. Currently, 5 months after the operation, follow-up is underway without recurrence.