Single-Incision Laparoscopic Intragastric Surgery for Gastric Submucosal Tumor Located Adjacent to Esophagogastric Junction: Report of Four Cases

Background: Laparoscopic local gastric resection has become the standard form of surgery for gastric submucosal tumors (SMTs) and is currently being actively selected for these cases. However, total gastrectomy or proximal gastrectomy is performed when tumors are adjacent to the cardia of stomach. Unfortunately, these procedures are highly invasive and can cause marked decreases in activities of daily living. We perform a single-incision laparoscopic intragastric surgery (sLIGS), which are both minimally invasive and offers improved cosmetic outcomes, to treat SMT located adjacent to the esophagogastric junction (EGJ). Methods: In this procedure, resection is performed from the gastric lumen side to completely eradicate the cancer while preserving the function of the cardiac sphincter. A 3-cm longitudinal skin incision and gastrotomy are made in the umbilical region, which are protected with a mini-size wound-protecting device. A dedicated wound sealer for single incision surgery is assembled on the wound-protecting device, and three 5 mm surgical ports are placed. Two 5mm ports are replaced with one 12 mm port to introduce surgical stapling device. The tumor is then staple-transected under countertraction provided by an ultrathin loop retracting device. Results: sLIGS has been performed in 4 patients, and none needed to be converted to open surgery. The median operative time was 149 (range 116-170) minutes and blood loss 30 (0-43) mL. No major perioperative complication was observed except for one case which was postoperative bleeding. Conclusion: sLIGS is a safe, realistic, and potentially effective procedure for gastric SMTs adjacent to the EGJ.