title: Single-incision transumbilical laparo-endoscopic gastric benign tumor resection.
abstract: BACKGROUND
  The authors report resection of a gastric benign tumor through single-incision laparoscopy, guided by peroperative gastroscopy. VIDEO: A 25-year-old man consulted after diagnosis of a 40 × 20 cm(2) 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 nondisposable 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, US) 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 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 (Fig. 1a), or between the surgeon's hands outside the abdomen (Fig. 1b). 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 min, 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 be safely performed through a single-access. Peroperative gastroscopy permits the limits of resection to be precisely determine, and use of curved and reusable instruments allows surgeon to achieve ergonomic conditions as in classic laparoscopy, without increasing the laparoscopic cost.
authors.affiliation: Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium. giovanni@dapri.net
authors.forename: Giovanni
authors.initials: G
authors.lastname: Dapri
authors.forename: Ruffin
authors.initials: R
authors.lastname: Ntounda
authors.forename: Jacques
authors.initials: J
authors.lastname: Himpens
authors.forename: Pietro
authors.initials: P
authors.lastname: Carnevali
authors.forename: Serena
authors.initials: S
authors.lastname: Scomersi
authors.forename: Guy-Bernard
authors.initials: GB
authors.lastname: Cadière
mesh_terms: D000328:Adult; D005743:Gastrectomy; D005773:Gastroscopy; D006801:Humans; D010535:Laparoscopy; D008297:Male; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*