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Page 2 of 7 Priego et al. Mini-invasive Surg 2018;2:6 I http://dx.doi.org/10.20517/2574-1225.2018.01

INTRODUCTION
Gastric submucosal tumors (GST) are rare, accounting for < 1% of gastrointestinal tumors. Currently,
[1]
surgical resection remains the only chance for cure .
Laparoscopic wedge resection is widely accepted as a choice of treatment for GST especially for tumors
in the anterior wall, lesser curvature, and greater curvature. However, the difficulty in accessing tumors
[1]
located in the posterior wall and esophagogastric junction (EGJ) requires alternative approaches .
Laparoscopic transgastric resection (LTR) is a novel technique of removing gastric tumors that are
unresectable by endoscopy due to their size and location. However, there are limited reports on this
[1-5]
technique as this clinical entity occurs rarely .

The aim of the article is to assess feasibility and oncological outcomes of the laparoscopic approach for
intraluminal GST located in the posterior wall and near the EGJ.

METHODS
A retrospective analysis of all patients with GST located at the EGJ underwent LTR at our institution from
January 2015 to February 2016 was performed.

Patient demographics, preoperative symptoms, imaging studies, operative data, complications, hospital
stay, and follow-up were analyzed.

Preoperative, postoperative and long-term clinical assessment
All the patients underwent a standard preoperative workup including physical examination, blood
analysis, chest X-ray, upper gastrointestinal barium meal X-ray study, oral endoscopy, eco-endoscopy and
computerized tomography scan [Figure 1].

Postoperatively, patients were placed on a clear liquid diet and discharged home on a soft diet. Follow-up
was performed approximately 1, 2, 4 weeks, the 6th and 12th months, then every year after surgery where
an oral endoscopy was performed.

Histopathologic diagnoses were gastrointestinal stromal tumor (GIST) in 2 cases and leiomyoma in the
other 2. Median tumor size was 3.45 cm (range 2.3-5.5 cm).

Patient’s position and trocar’s placement
The surgery was performed with the patient under general anesthesia and placed in a modified lithotomy
position. The surgeon stood between the patient’s legs with the camera surgeon on the patient’s right side
and the assistant on the left.

A four-port technique was employed in the upper abdomen: epigastric 5-mm ballon trocar, left
midclavicular 10-mm ballon trocar, left hipocondrium 12-mm ballon trocar and supraumbilical 10-mm
trocar (Applied Medical). Nathanson liver retractor was used in selected cases when the upper part of
stomach was covered with bulky liver [Figure 2].

Gastric wall incision and intragastric trocar insertion
Pneumoperitoneum was created with Veress needle in left upper hypocondrium and carbon dioxide was
insufflated to maintain the intra-abdominal pressure at 10-12 mmHg. A 30º-degree laparoscope was used.