Laparoscopic Intragastric Surgery Research Articles

Surgical tips and tricks for laparoscopic intragastric surgery for submucosal tumors relative to the esophagogastric junction.

Recent reports have described the practicality of laparoscopic intragastric surgery (l-IGS) as an alternative for resecting submucosal tumors (SMTs) near the esophagogastric junction (EGJ), where excision using an exogastric approach would be difficult. However, even using IGS to perform a full-thickness resection of SMTs that are in or extremely close to the EGJ is very difficult to do safely and avoid disrupting or causing stenosis of the EGJ, without advanced experience. This study retrospectively examined the usefulness of l-IGS for gastric SMTs located in or extremely close to the EGJ. Fourteen patients with gastric SMTs < 2cm of the EGJ and underwent l-IGS were eligible for this study. We examined the tumor location, operative time, intraoperative hemorrhage, degree of deformation, gastroesophageal reflux disease, perioperative complications, and recurrence. Furthermore, we compared patients with tumors in the EGJ with those with tumors near the EGJ and patients in whom three-port l-IGS was performed with those who underwent single-incision laparoscopic surgery. The average tumor size, operative time, intraoperative hemorrhage, and postoperative hospitalization of the 14 patients were 30.9 ± 21.3mm, 125.2 ± 31.1min, 30.7 ± 103.3mL, and 9.2 ± 3.1d, respectively. No differences in these parameters according to the type of l-IGS or tumor location were observed. All patients underwent l-IGS without complications and were free from EGJ deformation or esophagitis. We believe that l-IGS is useful for gastric SMTs located < 2cm of the EGJ as it can be safely performed for difficult tumor locations and does not cause deformation of the EGJ.

Combination of endoscopic full-thickness resection and laparoscopic intragastric surgery for gastric submucosal tumor.

Combination of endoscopic full-thickness resection and laparoscopic intragastric surgery for gastric submucosal tumor.

Single-Incision Laparoscopic Intragastric Surgery for Gastric Submucosal Tumors Located Near the Esophagogastric Junction.

Background: Laparoscopic local resection of the stomach for gastric submucosal tumors (SMTs) is widely accepted by surgeons. For SMTs located near the esophagogastric junction (EGJ), simple laparoscopic wedge resection is rarely performed owing to concerns of causing cardia deformities or stenosis. Single-incision laparoscopic intragastric surgery (sLIGS) has been used to treat SMTs located near the EGJ in carefully selected cases. Methods: We modified sLIGS using a subxiphoid incision. Thirteen consecutive patients with intraluminal or intramural growth type gastric SMTs located near the EGJ underwent sLIGS at our institution from July 2018 to April 2020. Results: Thirteen operations were successfully performed using sLIGS, including eight full-thickness resections and five submucosal resections. There were no conversions to an open procedure and all tumors were confirmed to have negative margins on pathology. The mean operation time was 100 ± 10 minutes (range, 85-160 minutes). The mean blood loss was 50 ± 10 mL (range, 50-100 mL). The mean length of postoperative hospital stay was 7 ± 1.5 days (6-10 days). One patient was found to have oozing of blood confirmed by gastroscopy postoperatively and recovered after stopping antiplatelet therapy. Ten cases were gastrointestinal stromal tumor (GIST), two cases were leiomyoma, and one case was neuroendocrine neoplasm. Of the 10 GISTs, 9 were classified as low risk; 1 showed medium risk and the patient received adjuvant imatinib therapy. There were no tumor recurrences during a mean follow-up of 14 ± 4 months (range, 5-25 months). Conclusions: This modified sLIGS for the treatment of the gastric SMTs located near the EGJ is simple and safe. This can be used as an alternative treatment for gastric SMTs near the EGJ.

Résultats de la résection intra-gastrique laparoscopique

BackgroundTechnological and operative advancements have allowed laparoscopic intragastric surgery (LIGS) to be applied in the treatment of superficial gastric or submucosal lesions. The aim of this study was to evaluate short- and long-term outcomes following LIGS. MethodsFrom 2000 to 2013, 25 LIGSs were performed for superficial gastric lesions. Clinical records were reviewed retrospectively for perioperative course and long-term outcomes with particular attention to the oncological follow-up for patients with malignant lesions. ResultsNineteen (76 %) lesions were located close to the EGJ, three (12 %) in the lesser curvature, two (8 %) in the posterior wall and one (4 %) in the prepyloric antral region. A multiport technique was used in 15 (60 %) patients and a single access approach in 10 (40 %) patients. The median operative time was 140 (50–210) minutes. No conversion to open or conventional laparoscopic surgery was needed. Mortality was nil, and severe morbidity occurred in one (4 %) patient. The median length of stay was 6 (3–10) days. Indications of LIGS were adenocarcinoma in 11 (44 %) patients, gastrointestinal stromal tumors (GISTs) in 6 (24 %) patients and benign lesions in eight (32 %) patients. En bloc resection was obtained in 24 (96 %) patients with R0 margins in 23 (92 %) patients. After a median follow-up of 76 (26–171) months, recurrence was detected in 4 (36 %) patients with advanced malignant adenocarcinoma. ConclusionLIGS provides an interesting alternative to major gastric and EGJ resection when endoscopic resection is not suitable for highly selected patients with superficial gastric lesions.

Results of laparoscopic intragastric surgery.

Technological and operative advancements have allowed laparoscopic intragastric surgery (LIGS) to be applied in the treatment of superficial gastric or submucosal lesions. The aim of this study was to evaluate short- and long-term outcomes following LIGS. From 2000 to 2013, 25 LIGSs were performed for superficial gastric lesions. Clinical records were reviewed retrospectively for peri-operative course and long-term outcomes with particular attention to the oncological follow-up for patients with malignant lesions. Nineteen (76%) lesions were located close to the EGJ, three (12%) in the lesser curvature, two (8%) in the posterior wall and one (4%) in the prepyloric-antral region. A multiport technique was used in 15 (60%) patients and a single-access approach in 10 (40%) patients. The median operative time was 140 (50-210) minutes. No conversion to open or conventional laparoscopic surgery was needed. Mortality was nil, and severe morbidity occurred in one (4%) patient. The median length of stay was 6 (3-10) days. Indications of LIGS were adenocarcinoma in 11 (44%) patients, gastrointestinal stromal tumors (GISTs) in 6 (24%) patients and benign lesions in eight (32%) patients. En bloc resection was obtained in 24 (96%) patients with R0 margins in 23 (92%) patients. After a median follow-up of 76 (26-171) months, recurrence was detected in 4 (36%) patients with advanced malignant adenocarcinoma. LIGS provides an interesting alternative to major gastric and EGJ resection when endoscopic resection is not suitable for highly selected patients with superficial gastric lesions.

Clinical efficacy of modified totally laparoscopic intra-gastric surgery for submucosal tumors adjacent to the gastric cardia or pylorus

Objective To explore the clinical efficacy of modified totally laparoscopic intra-gastric surgery for the treatment of submucosal tumors adjacent to the cardia or pylorus. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 48 patients with gastric submucosal tumors adjacent to the cardia or pylorus between September 2014 and March 2018 were collected. There were 22 males and 26 females, aged from 38 to 78 years, with an average age of 58 years. Patients were performed multi-port or single-port modified laparoscopic intra-gastric surgery. Observation indicators: (1) surgical treatments; (2) postoperative recovery; (3) results of postoperative pathological examination; (4) follow-up. Patients were followed up by outpatient examination and telephone interview to detect the postoperative complications and tumor metastasis and recurrence up to June 2018. Measurement data with normal distribution were expressed as Mean±SD and measurement data with skewed distribution were described as M (range). Count data were represented as absolute number or percentage. Results (1) Surgical treatments: 48 patients underwent modified totally laparoscopic intra-gastric surgery successfully, including one patient combined with proximal gastrectomy, without conversion to open surgery. Of the 48 patients, 43 underwent multi-port modified laparoscopic intra-gastric surgery and 5 underwent single-port modified laparoscopic intra-gastric surgery. The operation time and volume of intraoperative blood loss were 68 minutes (range, 45-110 minutes) and 20 mL (range, 5-100 mL). The oncologic evaluation of 48 patients: 48 patients had complete resection of tumors, without tumor rupture. The tumor diameter and distance from margin to tumor were 32 mm (range, 20-40 mm) and 6 mm (range, 5-10 mm). (2) Postoperative recovery: the time for initial oral intake and duration of postoperative stay were 2.8 days (rang, 1.0-5.0 days) and 5.3 days(range, 3.0-11.0 days). There were 4, 3, 1 and 1 patients complicated with surgical infection, delayed gastric emptying, sub-phrenic hydrops and digestive leakage respectively in the 48 patients. (3) Results of postoperative pathological examination: the distance from tumor margin to gastric cardia or pylorus, tumor diameter, circumferential resection margin were 15 mm (range, 0-30 mm), 24 mm (range, 10-65 mm), 6 mm (range, 5-10 mm), respectively. Growth patterns of cancer in the 48 patents included 27 of intraluminal type, 12 of intermural type, 9 of mixed type. Pathological types of 48 patients: there were 26 patients with leiomyoma, 9 with gastrointestinal stromal tumor, 4 with other rare tumors, 2 with carcinoid, 2 with mucosa-associated lymphoma, 2 with inflammatory fibrous polyps, 2 with gastritis cystica profunda, 1 with ectopic pancreas. (4) Follow-up: 41 of the 48 patients were followed up for 3-48 months, with a median follow-up time of 22 months. No tumor recurrence was detected in 37 of 41 patients by 3 times of gastroscopy and no stenosis or dysfunction of cardia or pylorus was detected in 39 patients by 2 times of upper gastrointestinal imaging (one patient undergoing two examinations) . During the follow-up, there was no surgery-related complication or tumor-specific death. Conclusion Modified totally laparoscopic intra-gastric surgery is safe and feasible for the treatment of gastric submucosal tumors adjacent to the cardia or pylorus. Key words: Submucosal tumors; Intra-gastric surgery; Cardia; Pylorus; Laparoscopy

Totally Laparoscopic Transluminal Resection for Gastrointestinal Stromal Tumors Located at the Cardiac Region

The most common laparoscopic surgery for gastric gastrointestinal stromal tumors (GISTs) currently includes laparoscopic wedge resection, laparoscopic transgastric surgery, and laparoscopic intragastic surgery [Ohashi in Surg Endosc 9:169-171, 1995]. The clinical data of 10 cases of cardiac endophytic GIST patients who received total laparoscopic intragastric surgery from June 2014 to March 2016 in Guangdong General Hospital were retrospectively analyzed. All cases were operated successfully without conversion to laparotomy. Operative time ranged from 59 to 104min and blood loss was 5-65mL. All specimens had intact capsules, diameters ranged from 16 to 26mm, circumferential resection margins were 9-15mm, and basement resection margins were 4-8mm. All cases were pathologically diagnosed with GISTs. Time of flatus ranged from 1 to 4days, time to resume eating was 2-4days, drainage removal time was 3-4days, and discharge time was 4-6days. There was no postoperative hemorrhage, anastomotic leakage, cardiac stenosis, or other complications. All patients showed no swallowing disorders or acid reflux, and there were no signs of recurrence or metastasis in the follow-up period. Total laparoscopic intragastric treatment for cardiac endophytic GISTs is safe and feasible; however, an advanced laparoscopic surgical technique is required, which needs to be performed with caution.

Tensionless Purely Laparoscopic Intra-Gastric Surgery using an Innovative Mucosal Flap-Valve Mechanism: The Jategaonkar Technique.

Cooperative laparoscopic endoscopic intra-gastric surgery, with its ability to acquire advantages of both these technologies, is a recent development in the field of minimally invasive surgery. However, the pre-requisition of its multi-disciplinary approach together with several technical constraints have, plausibly, limited its widespread acceptance. The ever-increasing number of modifications being reported in today's literature largely underscores the inability of any one to be the best. We illustrate a novel, simple-to-learn, rapid and potentially cost-effective technique of intra-gastric surgery using just the routine laparoscopic instruments, and name it the 'Jategaonkar technique'. We have practised it in seven consecutive patients without any complications; and hence, recommend it for regular application. Such a method is yet to be described in the literature.

Gastric liposarcoma resected by laparoscopic total gastrectomy to achieve a wide surgical margin

Gastric liposarcoma is an extremely rare tumour that usually affects the extremities and retroperitoneum. Preoperative diagnosis is difficult, and operative procedures are not well standardised. A 61-year-old woman presented with...

Totally laparoscopic intragastric surgery for gastric submucosal tumors located near the esophagogastric junction

Background: Laparoscopic partial gastrectomy (LAP) is a standard treatment for gastric submucosal tumors (SMTs). However, for SMTs located in the special parts such as the esophagogastric junction (EGJ) or the lesser curvature, LAP is difficult to approach with considerable risk of causing deformity or stenosis, tumor must be exposed via gastrotomy or handled by laparoscopic intragastric surgery (LIGS). We designed the totally laparoscopic intragastric surgery (T-LIGS), and describe this procedure and its clinical outcomes for gastric SMTs. Methods: Fourteen consecutive patients with gastric intraluminal SMTs located near the EGJ underwent T-LIGS at our center from January 2012 to December 2014. The clinicopathological results of these 14 cases were analyzed. Results: T-LIGS was successfully performed on all the patients. The mean operation time was 71.1±22.2 min (range, 45–110 min) and the mean blood loss was 9.3±7.0 mL (range, 5–30 mL). There was no death or intraoperative complications in our series. One patient experienced a postoperative complication of gastroparesis, one patient experienced surgical site infection, both recovered after conservative treatment. The mean postoperative length of hospital stay was 6.6±1.7 days (range, 5–11 days). All patients received complete resection with a negative margin. Histopathologic diagnoses were gastrointestinal stromal tumor (GIST) in nine cases, neurofibroma in two, neuroendocrine tumor (NET) in two, and mucosa associated lymphoid tissue lymphoma in one. There was one case of stenosis of the EGJ, and no case of tumor recurrence, during a mean follow-up of 13.9±7.4 months (range, 6–30 months). Conclusions: T-LIGS is a safe, feasible, and effective procedure, its suitable for treatment of gastric SMTs located near the EGJ.

Intragastric Laparoscopic Surgery: An Option for Gastric Lesions not Resectable by Endoscopy

Gastric mucosal and submucosal lesions can be resected by endoscopy, laparoscopy or open surgery. Operative methods have varied depending on the location, endophytic growth and size of the lesion.Interest in minimally invasive surgery has increased and many surgeons are attempting laparoscopic approaches, especially in lesions of the stomach near the esophagogastric junction not amendable to endoscopic removal, because conventional surgery can produce stenosis and distort the postoperative anatomy, and increase morbimortality.We report our experience with laparoscopic intragastric surgery in 3 consecutive patients, with no complications.Laparoscopic intragastric surgery extends the surgeons’ armamentarium to resect complex gastric lesions, while offering patients the benefits of minimal access surgery.

Laparoscopic Intragastric Surgery for Gastric Tumor to Preserve Cardia Function Under Augmented Reality Navigation System: The First Application for Child Case

Abstract Introduction: Laparoscopic intragastric surgery was demonstrated to remove the lesion of posterior wall of stomach.1 We performed this procedure for the pediatric rare disease not only to ...

Cirugía laparoscópica intragástrica: una opción en lesiones gástricas no resecables endoscópicamente

Gastric mucosal and submucosal lesions can be resected by endoscopy, laparoscopy or open surgery. Operative methods have varied depending on the location, endophytic growth and size of the lesion.Interest in minimally invasive surgery has increased and many surgeons are attempting laparoscopic approaches, especially in lesions of the stomach near the esophagogastric junction not amendable to endoscopic removal, because conventional surgery can produce stenosis and distort the postoperative anatomy, and increase morbimortality.We report our experience with laparoscopic intragastric surgery in 3 consecutive patients, with no complications.Laparoscopic intragastric surgery extends the surgeons’ armamentarium to resect complex gastric lesions, while offering patients the benefits of minimal access surgery.

Clinical Control Study of Endoscopic Full-thickness Resection and Laparoscopic Surgery in the Treatment of Gastric Tumors Arising from the Muscularis Propria.

Background:Gastric stromal tumors arising from the muscularis propria are located in deeper layers. Endoscopic resection may be contraindicated due to the possibility of perforation. These tumors are therefore usually removed by surgical or laparoscopic procedures. This study evaluated the curative effects, safety and feasibility of endoscopic full-thickness resection (EFR) of gastric stromal tumors originating from the muscularis propria.Methods:This study enrolled 92 patients with gastric stromal tumors >2.5 cm originating from the muscularis propria. Fifty patients underwent EFR, and 42 underwent laparoscopic intragastric surgery. Operation time, complete resection rate, length of hospital stay, incidence of complications, and recurrence rates were compared in these two groups.Results:EFR resulted in complete resection of all 50 gastric stromal tumors, with a mean procedure time of 85 ± 20 min, a mean hospitalization time of 7.0 ± 1.5 days and no complications. Laparoscopic intragastric surgery also resulted in a 100% complete resection rate, with a mean operation time of 88 ± 12 min and a mean hospitalization period of 7.5 ± 1.6 days. The two groups did not differ significantly in operation time, complete resection rates, hospital stay or incidence of complications (P > 0.05). No patient in either group experienced tumor recurrence.Conclusions:EFR technique is effective and safe for the resection of gastric stromal tumors arising from the muscularis propria.

腹腔鏡下胃内手術を行ったball valve syndromeをきたした胃穹窿部GISTの1例

腹腔鏡下胃内手術を行ったball valve syndromeをきたした胃穹窿部GISTの1例

Laparoscopic intragastric approach for gastroesophageal leiomyoma and cancer

Laparoscopic intragastric surgery was first described by Ohashi. We report our technique in the management of gastroesophageal junction (GEJ) leiomyoma and superficial cancers. This technique allows for excellent exposure of the pathology of the GEJ with minimal dissection of the stomach or disruption of the vagi. For leiomyoma, all patients undergo endoscopic biopsy to rule out a gastrointestinal stromal tumor before local excision.

Modified laparoscopic intragastric surgery and endoscopic full-thickness resection for gastric stromal tumor originating from the muscularis propria

This study aimed to evaluate the feasibility and security of the modified laparoscopic intragastric surgery (MLIGS) and the endoscopic full-thickness resection (EFR) for the treatment of gastric stromal tumors (GSTs) originating from the muscularis propria. The study population was 18 patients with GSTs of the intraluminal muscularis propria layer. Eight were treated by MLIGS performed according to the following procedures: (1) gastroscopy was used to expose and confirm the location of the tumor; (2) a laparoscope light was placed in the cavity using the trocar at the navel, with the remaining two trocars penetrating both the abdominal and stomach walls; (3) the operation was performed in the gastric lumen using laparoscopic instruments with gastroscope monitoring, and the tumor was resected; (4) the tumor tissue was removed orally using a grasping forceps; (5) and the puncture holes and perforation in the stomach were sutured using titanium clips. The remaining 10 patients were treated by EFR, which involved (1) injection of normal saline into the submucosa and precutting of the mucosal and submucosal layer around the lesion, (2) a circumferential incision as deep as the muscularis propria around the lesion, (3) an incision into the serosal layer around the lesion, (4) completion of full-thickness incision to the tumor, (5) closure of the gastric wall defect with clips. The GSTs all were resected completely. The two groups did not differ significantly in terms of tumor size, hospital stay, or abdominal pain time. But in the MLIGS group, the operation time and blood loss were significantly decreased compared with the EFR group. No postoperative complications occurred in the MLIGS group, whereas one peritoneal abscess occurred in the EFR group. The pathology of all the resected specimens showed GST. No case of implantation or metastasis was found. Both MLIGS and EFR are feasible and effective treatments for GSTs from the muscularis propria. Moreover, both are minimally invasive.

Laparoscopic Intragastric Surgery for Early Gastric Cancer and Gastrointestinal Stromal Tumors

T1a gastric cancer and gastrointestinal stromal tumors (GIST) often require extensive resection despite their favorable tumor biology. This holds especially true for lesions located at the gastroesophageal junction. In this video we will demonstrate an oncologically sound technique of laparoscopic intragastric surgery that allows for safe and effective tumor resection. The first patient has a T1a gastric adenocarcinoma with no adverse features at the gastroesophageal junction. The tumor is resected with multiple cuffed ports placed directly into the stomach. The specimen is removed via the mouth. The next video shows the use of multi-port access to resect a 6cm GIST at the cardia. An endoloop is used to provide safe manipulation with minimal handling of the GIST itself. The third patient has a small 1.5cm GIST, and a single incision access device is used for stapled removal of this tumor located at the gastroesophageal junction. The video shows safe and feasible techniques for intragastric surgery to remove early gastric cancer and GIST. We demonstrate the use of multiple ports and single access, as well as stapling inside the stomach. The technique of intragastric laparoscopic surgery allows for safe removal of T1a gastric cancer too extensive for endoscopic resection. At this point, gastric adenocarcinomas of <4-5cm, with no submucosal, lymphatic, or vascular invasion or ulceration and no suspicion for lymph node metastasis should undergo this treatment. Excellent visualization, the ability to perform full-thickness resection and manage perforations make this new technique an excellent treatment option for early gastric cancer and GIST.

New-style laparoscopic and endoscopic cooperative surgery for gastric stromal tumors

To evaluate the feasibility and safety of a new style of laparoscopic and endoscopic cooperative surgery (LECS), an improved method of laparoscopic intragastric surgery (LIGS) for the treatment of gastric stromal tumors (GSTs). Six patients were treated with the new-style LECS. Surgery was performed according to the following procedures: (1) Exposing and confirming the location of the tumor with gastroscopy; (2) A laparoscopy light was placed in the cavity using the trocar at the navel, and the other two trocars penetrated both the abdominal and stomach walls; (3) With gastroscopy monitoring, the operation was carried out in the gastric lumen using laparoscopic instruments and the tumor was resected; and (4) The tumor tissue was removed orally using a gastroscopy basket, and puncture holes and perforations were sutured using titanium clips. Tumor size ranged from 2.0 to 4.5 cm (average 3.50 ± 0.84 cm). The operative time ranged from 60 to 130 min (average 83.33 ± 26.58 min). Blood loss was less than 20 mL and hospital stay ranged from 6 to 8 d (average 6.67 ± 0.82 d). The patients were allowed out of bed 12 h later. A stomach tube was inserted for 72 h after surgery, and a liquid diet was then taken. All cases had single tumors which were completely resected using the new-style LECS. No postoperative complications occurred. Pathology of all resected specimens showed GST: no cases of implantation or metastasis were found. New-style LECS for GSTs is a quick, optimized, fast recovery, safe and effective therapy.

An analysis of endoscopy-assisted and laparoscopic intragastric surgery in an experimental model of gastric submucosal pseudotumor

An analysis of endoscopy-assisted and laparoscopic intragastric surgery in an experimental model of gastric submucosal pseudotumor