Fig. 3

LECS procedure for dissection of the SMT. After the tumor location had been confirmed by intraluminal scope, blood vessels in the excision area around the tumor were minimally ligated using an ultrasonically activated device. The letter S indicates spleen, and the letter of L indicates liver (a). Endoscopic submucosal dissection was performed around the tumor (b). The seromuscular layer was intentionally perforated after three-quarters of the circumference of the excision had been finished (c). The tip of an ultrasonically activated device was inserted into the perforation and seromuscular dissection around the tumor performed (d)