Single Incision Transumbilical Laparo-Endoscopic Gastric Benign Tumor Resection

Giovanni Dapri, MD, Ruffin Ntounda, MD, Lorenzo Casali, MD, Pietro Carnevali, MD, Jacques Himpens, MD, Guy-Bernard Cadi&#232re, MD PhD. European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium

Introduction: The authors report the resection of a gastric benign tumor through single incision laparoscopy, guided by peroperative gastroscopy.
Video: A 25 years old man consulted after diagnosis of a 40 x 20 cm endoluminal lesion of the gastric cardia. Preoperative work-up showed a stromal tumor with invasion of the muscular layer. The umbilical scar was incised and, after placement of a purse-string suture, an 11-mm non disposable trocar was inserted for a 10-mm 30° angled scope. Curved and reusable instruments (Karl Storz-Endoskope, Tuttlingen, Germany), and straight ultrasonic shears (Ethicon Endosurgery, Cincinnati, OH) were inserted transumbilically. Peroperative gastroscopy located the lesion on the smaller gastric curvature, 1 cm from the gastroesophageal junction. A stitch was placed in the center of the lesion, and gastroscopic grasper helped in maintaining the limits of the resection. Gastrostomy was closed using two converting absorbable running sutures. Because of the curves of the instruments there was no conflict between the instruments’ tips inside the abdomen, or between the surgeon’s hands outside the abdomen. Leak-test with the gastroscope checked the integrity of the suture. The specimen was retrieved transumbilically in a plastic bag.
Results: Operative time was 150 minutes, and the umbilical incision was less than 15 mm. The patient was discharged after 5 days, and he is doing well 3 months postoperatively.
Conclusions: Laparoscopic gastric resection can safely be performed through a single access. Peroperative gastroscopy permits to precise the limits of the resection, and the use of curved and reusable instruments allows surgeon to achieve ergonomic conditions as in classic laparoscopy, without increasing of the laparoscopic cost.