title: Comparison of minilaparoscopy and single-incision intragastric surgery for gastric submucosal tumor resection in a porcine model.
abstract: The aim of this study was to develop an easy-to-induce and reproducible model of gastric submucosal tumor in swine to compare minilaparoscopy (ML) with single-incision (SI) intragastric surgery.
  
  
  
  Twelve healthy female pigs (weight 30.94 ± 2.49 kg) underwent a transparietal injection of sterile alginate at the level of Z-line (n = 6) and at the pre-pyloric area (n = 6) creating a model of gastric submucosal pseudotumor. The operative procedures included intragastric resection with ML and SI approaches of cardiac and pre-pyloric lesions, with gastroscopic assistance. After resection, the gastric mucosal layer was closed using intracorporeal sutures. The operative time, complication rate and clinical evolution after 1 month were compared in the four groups that the pigs were arranged.
  
  
  
  The pseudotumors ranged in size from 3 to 6 cm in diameter. The access of the gastric cavity and resection of the experimental SMP and suturing of the mucosa were performed successfully in 12 animals using both approaches. Mean time to perform the exeresis of gastric cardia tumors was significantly higher in single-incision approach. No significant differences were observed in the surgical time during pyloric surgery. Minilaparoscopic approach reduced significantly the mucosa closure time in esophagogastric and pyloric pseudotumors. One month after, no alterations were shown in the abdominal cavity using exploratory laparotomy.
  
  
  
  The technical feasibility of performing safe and efficient intragastric approach of submucosal pseudotumors in swine model was verified in this study. Intragastric ML has advantages over SI, namely regarding the reduction in total surgical times and the fewer technical difficulties.
authors.affiliation: Minimally Invasive Surgery Centre Jesús Usón, Ctra. N-521, km 41,8, 10171, Cáceres, Spain. msanchez@ccmijesususon.com.
authors.forename: F M
authors.identifier: 0000-0003-2138-988X
authors.initials: FM
authors.lastname: Sánchez-Margallo
authors.affiliation: Minimally Invasive Surgery Centre Jesús Usón, Ctra. N-521, km 41,8, 10171, Cáceres, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Pérez López
authors.affiliation: Minimally Invasive Surgery Centre Jesús Usón, Ctra. N-521, km 41,8, 10171, Cáceres, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Tapia Araya
authors.affiliation: Surgery Department, University of Extremadura, Cáceres, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Usón Casaús
mesh_terms: D000818:Animals; D005260:Female; D005743:Gastrectomy / Q000379:methods; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods; D010535:Laparoscopy / Q000379:methods; D023421:Models, Animal; D061646:Operative Time; D011897:Random Allocation; D013274:Stomach Neoplasms / Q000601:surgery*; D013537:Sutures; D013552:Swine
keywords: Endoscopy; Gastric submucosal tumor; Intragastric approach; Minilaparoscopy; Pig; Single-incision surgery