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Hybrid Laparoscopic and Endoscopic Partial Gastrectomy for Ulcerated GIST: Surgical Technique with Video

  • Dimitrios NtourakisEmail author
  • Adamantios Michalinos
  • Dimitrios Schizas
Innovative Surgical Techniques Around the World
  • 15 Downloads

Abstract

Introduction

Gastrointestinal stromal tumors of the gastric cardia pose several technical difficulties to their resection because they are difficult to access, and they must be removed respecting oncological principles, and due to their proximity to the gastroesophageal junction, excessive removal of gastric tissue may cause deformation with gastric dysfunction, or gastroesophageal reflux.

Method

Hybrid laparoscopic endoscopic partial gastrectomy is a technique that avoids these problems making use of three principles. First the tumor is pinpointed, marked, and resected under combined laparoscopic and endoscopic control to assure that it is completely resected without compromising the structure of the gastroesophageal junction. Second, a dissection of the abdominal esophagus is performed as during a Nissen fundoplication in order to increase the distance between the tumor and the gastroesophageal junction. Third the lesser curvature of the stomach is dissected, and the terminal branches of the left gastric vessels are controlled from the gastric incisura to the gastroesophageal junction exposing the lesser curvature and the posterior wall of the stomach. The tumor is resected under endoscopic control, tangentially with an endoscopic stapler applied parallel to the lesser curvature similarly to a sleeve partial gastrectomy.

Results

No abdominal drain is used, and a nasogastric tube is left in place for the first 24 h after surgery. The patient receives fluid diet on the first postoperative day, is discharged on the second postoperative day, and is followed up in the outpatient department for a week.

Conclusion

In this technical paper, the procedure is described in detail and demonstrated with video.

Notes

Acknowledgements

The authors would like to acknowledge the gastroenterologists Dr. Sotirios Georgopoulos, Dr. Pavlos Antoniou, and Dr. Stephanos Basioukas for their invaluable contribution in patient selection and for participating in the procedure.

Funding

This work did not receive any funding.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to declare.

Supplementary material

268_2019_5192_MOESM1_ESM.mp4 (132.4 mb)
Hybrid Gastric GIST resection WJS.mpg (MP4 135605 kb)

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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  1. 1.Minimally Invasive Surgery Unit, Paleo Faliro ClinicAthens Medical CenterPaleo Faliro, AthensGreece
  2. 2.Department of Surgery, School of MedicineEuropean University CyprusNicosiaCyprus
  3. 3.First Department of Surgery, Laikon General HospitalNational and Kapodistrian University of AthensAthensGreece

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