Intragastric Single Port Surgery (IGS) as an simple solution for complex problems: Benign gastric tumors, bleeding lesions and review of anastomosis (Video)

Einleitung:

Benign gastric tumors can be challenging for either endoscopic or surgical treatment. 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.

Ziele:

Strategies on achieving tumor- free margin intragastric resections.

Methodik:

The video describes the experience with the new IGS technique for 18 patients with submucosal tumors with a diameter range between 3 – 6 cm encompassing GISTs, Dieulafoy angiodysplasia and other indications. 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 45 mm linear staplers und endoscopic guidance and the tumor was retrieved through the single port access. Finally the gastric incision was closed percutaneously.

Ergebnisse:

The operative time lasted between 42 and 134 minutes for the intragastric surgery. No intraoperative complications were observed. 2 patients had a staple line bleeding, therapy was endoclips only.One patient developed a wound infection. All resection margins were tumor free. Postoperative control at POD 15 revealed no complications.

Fig. 1: Schematic view of intragastric Single-Port (IGS) for intragastric tumor resection.

Schlussfolgerung:

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.