• Cindy Boulanger-Gobeil, Jean-Pierre Gagné, François Julien, Valérie Courval, Kaitlyn Beyfuss, Shady Ashamalla, and Julie Hallet.
• Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
• Ann. Surg. 2018 Feb 1; 267 (2): e12-e16.

ObjectiveTo present the technique for and early results of laparoscopic intragastric resection (LIGR).BackgroundTreatment of confirmed or suspected submucosal gastric malignancies relies on clear margin resection, for which minimally invasive surgery is widely accepted. However, resection in some localization remains challenging.MethodsWe present the steps of LIGR for gastric submucosal tumors (GSMTs). We report the results of LIGR in consecutive patients operated at 2 institutions, including intraoperative, pathologic, 30-day major morbidity and mortality characteristics.ResultsAfter laparoscopic access to the abdominal cavity, cuffed gastric ports are placed to approximate the anterior gastric wall to the abdominal wall. A pneumogastrum is created. The tumor is resected in the submucosal plane and the deficit closed with intragastric suturing. Specimen extraction is performed perorally or through a gastrotomy site. In 8 proximal intraluminal GSMTs with median size of 3.1 cm (range: 1.8-6.0 cm), median operative time was 167.5 minutes (range: 120-300 mins). There was no major morbidity and no mortality. All resections were R0.ConclusionsWe illustrate the technique of a novel, feasible, and safe minimally invasive approach to GSMTs. LIGR is an alternative to resect challenging GSMTs by limiting surgical invasiveness and preserving gastrointestinal function.

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