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Single-port intragastric wedge resection using the tunnel method: a novel surgical approach for treating endophytic gastric subepithelial tumors

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Abstract

Background

Intragastric wedge resection is an effective method for treating endophytic gastric subepithelial tumors (SETs). However, retracting the stomach wall to the umbilicus is difficult in certain patients. In response, we developed a novel surgical technique for single-port intragastric wedge resection, which we termed the “tunnel method.”

Methods

A transumbilical incision is made, and a wound retractor is applied. After diagnostic laparoscopy, a gastrostomy is made on the greater curvature, lower body. Another small wound retractor is inserted into the gastrostomy, and extracted through the transumbilical incision, creating a tunnel from the gastrostomy site to the umbilicus. Articulating laparoscopic instruments are inserted via the tunnel, and intragastric wedge resection is performed. We collected and analyzed the clinicopathologic and operative data of patients who underwent intragastric wedge resection via the tunnel method.

Results

Twenty-seven patients who underwent single-port intragastric wedge resection via the tunnel method in a single tertiary referral hospital were included in this study. The mean age of the patients was 54.6 ± 11.4 years, body mass index was 26.5 ± 3.4 kg/m2. Twenty-four (88.9%) patients had tumors located in the upper third of the stomach. The average operative time was 65.0 ± 24.2 min. None of the patients experienced Clavien–Dindo grade IIIa or higher postoperative complications. The average postoperative hospital stay length was 2.5 ± 0.8 days. Thirteen gastrointestinal stromal tumors, nine leiomyomas, and one neuroendocrine carcinoma, schwannoma, lipoma, spindle cell proliferative lesion, and fibrotic lesion were pathologically diagnosed. The average tumor size was 2.6 ± 1.3 cm. All cases had negative resection margins.

Conclusions

Single-port intragastric wedge resection by the tunnel method is a feasible and safe approach for treating endophytic gastric SETs.

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Acknowledgements

This research was supported by a grant from the Korean Health Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (20006101), and a grant from Seoul National University Bundang Hospital (SNUBH 02-2015-0021).

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Author notes

  1. Eunju Lee and Donghyun Lim have contributed equally to this study as co-first authors.

Authors and Affiliations

  1. Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea

    Eunju Lee & Hyung-Ho Kim

  2. Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea

    Donghyun Lim, So Hyun Kang, Duyeong Hwang, Mira Yoo, Young Suk Park, Sang-Hoon Ahn & Yun-Suhk Suh

  3. Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea

    Young Suk Park, Sang-Hoon Ahn & Yun-Suhk Suh

  4. Department of Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea

    Hyung-Ho Kim

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  1. Eunju Lee
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  2. Donghyun Lim
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Corresponding author

Correspondence to Sang-Hoon Ahn.

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Disclosuers

Sang-Hoon Ahn is a consultant for the company LIVSMED, while Eunju Lee, So Hyun Kang, Donghyun Lim, Duyeong Hwang, Mira Yoo, Young Suk Park, Yun-Suhk Suh, and Hyung-Ho Kim have no conflicts of interest to disclose.

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Lee, E., Lim, D., Kang, S.H. et al. Single-port intragastric wedge resection using the tunnel method: a novel surgical approach for treating endophytic gastric subepithelial tumors. Surg Endosc 38, 1106–1112 (2024). https://doi.org/10.1007/s00464-023-10583-z

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