Laparoendoscopic Removal of a Benign Gastric Stromal Tumor at the Cardia

OBJECTIVE Gastrointestinal stromal tumors are the most common submucosal masses in the stomach and are mostly benign. Minimally invasive surgery is being increasingly used for their excision. Tumors close to the cardia often require a stapled resection of stomach. We report a technique for enucleating a 4-cm, well-circumscribed gastric submucosal tumor at the cardia, avoiding gastric transection. METHODS A gastroscope was introduced to distend the stomach. A laparoscope was inserted through the umbilicus after pneumoperitoneum was created. Two 5-mm metal trocars were inserted into the stomach under vision. A 10-mm trocar was passed through the umbilical incision into the stomach for the camera. Dilute epinephrine was injected submucosally. The tumor was enucleated after incising the overlying mucosa. A gastroscope snare helped in grasping the tumor for retraction and final removal in a plastic bag. The submucosal defect and gastric port-site defects were sutured laparoscopically with Vicryl 3-0. RESULTS Contrast studies showed no leakage. Final histology indicated a benign leiomyoma. The patient was discharged on the sixth day. No recurrence was noted at 6-month follow-up. CONCLUSION Benign stromal tumors at the cardia can be safely enucleated by this method. This technique is cost-effective as it avoids expensive staplers or self-retaining gastric balloon ports.