gms | German Medical Science

Introduction: Benign gastric tumors can be challenging for either endoscopic or surgical treatment. A local gastric resection is usually indicated in tumors with a diameter beyond 3cm if full-thickness resection is needed or endoscopic R0 removal is impossible. The increasing application of laparoscopic techniques with stapled wedge resection is potentially leading to unnecessary loss of unaffected gastric tissue. As an alternative we present a video of a new technique of intragastric single port surgery (IGS) for the resection of solitary large benign tumors of the stomach.

Methods: Five patients with benign tumors localized at submucosa level with a diameter range between 3-6cm encompassing GISTs, Dieulafoy angiodysplasia and adenomas were included. A simultaneous intraoperative gastroscopy was performed in each patient in order to define the resection margins. As a next step the stomach wall is percutaneous exteriorized and a single port was introduced in the epigastric space under direct vision. Afterwards part of the ventral gastric wall was eviscerated and fixed at the abdominal wall. The resection was performed with 60mm linear staplers und endoscopic guidance and the tumor was retrieved through the single port access. Hand-sutured oversewing was outinely performed through single port. Finally the gastric incision was closed percutaneously.

Results: The operation time lasted between 42 and 58 minutes for the intragastric surgery. No intraoperative complications were observed. One patient developed a wound infection. All resection margins were tumor free. Postoperative control at POD 15 revealed no complications.

Conclusion: The concept of percutaneous intragastric single port gastric surgery (IGS) facilitates the minimal invasive resection of large benign gastric tumors with reduced loss of unaffected gastric tissue.