title: [Transgastric laparo-endoscopic approach for difficult access lesions. Experimental mode].
abstract: BACKGROUND
  Gastric neoplasms can be treated by laparoscopy in a safe and efficient way. Some lesions are not accessible to laparoscopic surgery due to their location. A transgastric approach is proposed as an alternative.
  
  
  OBJECTIVE
  Show the results with the application of an endoscopic laparotomy in an animal model that maintains functional anatomy, to resect the posterior gastric neoplasms of the stomach wall, close to the cardia and pre-pyloric region.
  
  
  METHODS
  The laparo-endoscopic technique for resection of gastric neoplasms located in the posterior wall was developed in twelve pigs at the Hospital General Gea González from May to December 2011.
  
  
  METHODS
  An endoscopy was performed to establish the site of insertion of intragastric trocars. Three gastrotomies were made in the anterior wall; under endoscopic and laparoscopic vision the trocars were inserted. The stomach was insufflated with CO2. The lesion was resected maintaining a 20 mm circumferencial margin. The gastrotomies were sutured. The statistic analysis was made with t Student and exact Fisher tests.
  
  
  RESULTS
  One-hundred percent of resections were achieved in an average time of 102.33 minutes (± 4.50). Two complications and no transoperatory deceases occurred.
  
  
  CONCLUSIONS
  The technique we describe allows an appropriate approach to gastric lesions located in the posterior wall, those near to the esophagogastric juntion and the prepiloric region, due to the excellent exposure managed by working inside the stomach with a laparoscopic vision and the two intragastric movile ports.
  
  
  CONCLUSIONS
  The laparoscopic transgastric approach is feasible and safe for the resection of gastric neoplasms located in the posterior wall, those close to the esophago-gastric junction, and the pre-pyloric region.
authors.affiliation: División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México, Distrito Federal,Mexico. adachin@hotmail.com.
authors.forename: Marcel Adalid
authors.initials: MA
authors.lastname: Tapia-Vega
authors.affiliation: División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México, Distrito Federal,Mexico.
authors.forename: Carlos Ernesto
authors.initials: CE
authors.lastname: Morales-Chávez
authors.affiliation: División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México, Distrito Federal,Mexico.
authors.forename: Itzé
authors.initials: I
authors.lastname: Aguirre-Olmedo
authors.affiliation: División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México, Distrito Federal,Mexico.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Cuendis-Velázquez
authors.affiliation: División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México, Distrito Federal,Mexico.
authors.forename: Martín Edgardo
authors.initials: ME
authors.lastname: Rojano-Rodríguez
authors.affiliation: División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México, Distrito Federal,Mexico.
authors.forename: Luis Eduardo
authors.initials: LE
authors.lastname: Cárdenas-Lailson
mesh_terms: D000818:Animals; D004943:Esophagogastric Junction / Q000601:surgery; D005240:Feasibility Studies; D005743:Gastrectomy / Q000379:methods*; D005773:Gastroscopy / Q000379:methods*; D005774:Gastrostomy / Q000379:methods; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000379:methods*; D061646:Operative Time; D011708:Pylorus / Q000601:surgery; D013270:Stomach / Q000601:surgery*; D013274:Stomach Neoplasms / Q000601:surgery; D034421:Sus scrofa; D013552:Swine
keywords: Laparoscopic surgery; cirugía endoluminal; cirugía intragástrica; cirugía laparoscópica; endoluminal surgery; gastric neoplasms; intragastric surgery; neoplasias gástricas