INTRAGASTRIC SILS FOR GIST, A NEW CHALLENGE IN ONCOLOGIC SURGERY: FIRST EXPERIENCES

Background: Surgical removal is the only curative therapy for
gastrointestinal stromal tumor (GIST). Traditionally, this has
been achieved by open surgery. Since the last decade,
laparoscopic resection of gastric GISTs is a widely accepted
technique for these lesions with proven feasibility and safety
with advantages of faster recovery, less postoperative pain,
better cosmesis and shorter hospital stay. Despite these
advantages, the laparoscopic wedge resection has limitations:
GISTs, especially located at the posterior wall or near the
esophagogastric junction or near the pyloric ring, are more
difficult. Intragastric wedge resection, which offers a direct
visualization of the tumor during resection, may be beneficial
in these cases. We present our experience where a singleincision
transgastric resection of gastric GIST was performed
with the single incision laparoscopic surgery (SILS) port
placed through the anterior wall of the stomach. This
technique opens a new field for development of transgastric
SILS device. Introduction: For treatment of GISTs located at
unreachable areas, such as esophagogastric junction or pyloric
ring, laparoscopic resection cannot be applied easily. We used
SILS for intragastric resection of GISTs. Materials and
Methods: We report three cases of SILS for GIST of the
stomach with the SILS port placed intragastric through the
anterior wall of the stomach. A skin incision of only 2.5 cm
was made to perform this intervention (Figure). Results: Mean
age was 68.1 years (range, 53-86). Mean operative time was
74.6 minutes (range, 67-82). No intra-operative complications
occurred. No conversion was needed. All patients healed
without any complication. Re-alimentation was started on the
third postoperative day. Mean postoperative stay was 5 days
(range, 4-6). Mean size was 3.8 cm (range, 2.7-6.8).
Discussion: Single-incision laparoscopic intragastric resection
for treatment of GISTs located at unreachable areas, such as
esophagogastric junction or pyloric ring, is a safe and feasible
procedure allowing direct visualization of the lesion and better
control of the surgical margin. This intragastric SILS
technique offers a new field for development of SILS and
further research progress in oncologic surgery.