Non-exposure organ-preserving resection of gastric gastrointestinal stromal tumors using the CLEAN-NET technique.

Abstract

Gastric gastrointestinal stromal tumors (GISTs) require oncologically safe resection while preserving gastric function. The Combination of Laparoscopic and Endoscopic Approaches to Neoplasia with Non-Exposure Technique (CLEAN-NET) integrates laparoscopic and endoscopic guidance to achieve full-thickness gastric resection while minimizing deformity and preventing tumor exposure. We present a video demonstration of CLEAN-NET in a 73-year-old female with a 4 cm gastric GIST at the lesser curvature near the incisura angularis. A cooperative laparoscopic-endoscopic approach was employed, including endoscopic submucosal injection, circumferential seromuscular incision, and tumor eversion into the peritoneal cavity. Full-thickness resection was completed using a laparoscopic linear stapler without spillage. The patient recovered uneventfully, resumed oral intake early, and was discharged without complications. Pathology confirmed a low-risk GIST with negative margins. CLEAN-NET is a safe, reproducible, and organ-preserving technique for selected gastric GISTs.