Endoscopy Assisted Laparoscopic Resection for Gastric Submucosal Tumors Located Within 5cm From The Esophagogastric Junction; Combined Surgery at Difficult Localization

Objective: Removal of the lesion with safe surgical margins is often sufficient including GISTs. Endoscopic resections can become challenging or impossible even if the tumor was located near esophagogastric junction. Performing gastrectomy for these mostly benign lesions will also be a rather brutal treatment method in most cases.Therefore, alternative minimal invasive resection techniques and their reliability should be evaluated. The aim of this study is to evaluate the efficacy and safety of endoscopy-assisted laparoscopic transgastric resection method in proximally located submucosal tumors. Materials and methods: Transgastric combined endoscopic and laparoscopic surgery (CELS) with intragastric port was performed in one patient and Transgastric CELS with gastrotomy was performed in six patients who had tumor located near esophagogastric junction at XXX Hospital between February 2019 and February 2020. Results: The patients were included 3 men and 4 women with and average age of 45.8 years (range 25-70). In five of the cases, four ports and nathanson retractor were used for liver retraction. While three ports were used in one patient, the stomach was suspended with traction suture. In one patient, 5 ports were used. The average operation time was 88 minutes (range 59-140 min). While gastrostomy line was closed with linear stapler in two patients, laparoscopic hand sewing method was used in the remaining patients. No patient had intraoperative complications. Conclusion: We strongly suggest that the laparoscopic transgastric resection approach for submucosal tumors close to the gastroesophageal junction, is a feasible and safe method, when used in combination with endoscopy.