title: Needlescopic intragastric surgery facilitated by newly developed 2mm instruments.
abstract: BACKGROUND
  Intragastric surgery is a percutaneous endoluminal surgery in the stomach aimed at resection of tumors located at the esophagogastric junction (EGJ). We developed needlescopic intragastric surgery performed via 2 mm, 2 mm, and 5 mm ports (PEIGS-225).
  
  
  METHODS
  In cooperation with Niti-On Co., Ltd. we developed a series of 2 mm instruments including grasping forceps, a cannula, a laparoscope, an electrocautery, scissors, and a needle holder.
  
  
  METHODS
  Two 2 mm trocars and a 5 mm one are inserted into the gastric lumen percutaneously. Intragastric procedures are performed by the instruments brought through those three ports. The specimen is extracted via the esophageal-oral route. The defect in the gastroesophageal wall is closed by hand-suture. After the intragastric procedure, the 5 mm stab wound on the gastric wall is closed by hand-suture, while the 2 mm wounds are left untreated.
  
  
  METHODS
  Between March and August 2015 PEIGS-225 was performed in five patients.
  
  
  RESULTS
  There was no operative conversion. The mean operation time was 96 minutes. There were no perioperative complications. Pathological findings indicated that the margin was negative in all cases.
  
  
  CONCLUSIONS
  Needlescopic intragasric surgery performed via the smallest access (2 mm, 2 mm, 5 mm) is enabled by the 2 mm instruments developed by us.
authors.affiliation: a Department of Surgery , Medical Topia Soka ;
authors.forename: Eiji
authors.initials: E
authors.lastname: Kanehira
authors.affiliation: a Department of Surgery , Medical Topia Soka ;
authors.forename: Takashi
authors.initials: T
authors.lastname: Tanida
authors.affiliation: a Department of Surgery , Medical Topia Soka ;
authors.forename: Aya
authors.initials: A
authors.lastname: Kamei
authors.affiliation: a Department of Surgery , Medical Topia Soka ;
authors.forename: Masafumi
authors.initials: M
authors.lastname: Nakagi
authors.affiliation: b Department of Gastroenterology , Medical Topia Soka.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: b Department of Gastroenterology , Medical Topia Soka.
authors.forename: Sachiko
authors.initials: S
authors.lastname: Touma
mesh_terms: D004943:Esophagogastric Junction / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation* / Q000379:methods*; D061646:Operative Time; D013274:Stomach Neoplasms / Q000601:surgery*; D013525:Surgical Instruments
keywords: 2 mm instruments; Needlescopic surgery; endoluminal surgery; gastric submucosal tumor; intragastric surgery