Intragastric Endoscopic Assisted Single Incision Surgery for Gastric Leiomyoma of the Esophagogastric Junction

Single port laparoscopic surgery is becoming an alternative to conventional laparoscopic surgery as a new approach where all the conventional ports are gathered in just one multichannel port through only one incision. Appling this technical development, we have developed a new technique based on an intragastric approach using a single port device assisted by endoscopy (I-EASI: intragastric endoscopic assisted single incision surgery) in order to remove benign gastric lesions and GIST tumors placed in the posterior wall of the stomach or close to the esophagogastric junction or the gastroduodenal junction. We present a patient with a submucosal gastric tumor placed near the esophagogastric junction removed with this new approach. 1. Introduction Single port laparoscopic surgery is becoming an alternative to conventional laparoscopic approach in different procedures. The advantages of these techniques have still to be proven based on prospective randomized setting. But one of the main contributions of single port approach is a change in the mentality of those surgeons performing these techniques, since these new approaches open surgeons’ minds to potential combined approach based on the concept of NOTES (natural orifice Transendoscopic surgery) and MANOS (minilaparoscopy assisted by natural orifice) or to an increase in the use of minilaparoscopic instruments. Hybrid procedures are increasing in number seeking a reduced injury of the anterior abdominal wall and also allowing surgeons and endoscopists to work together more and more in the operating room trying to reduce the invasiveness, thereby improving patient recovery. Old concepts such us intragastric laparoscopic surgery may be improved by the combination of single port access and endoscopic approach in order to offer new alternatives to different entities. We have developed a new technique based on an intragastric approach using a single port device assisted by endoscopy (I-EASI: intragastric endoscopic assisted single incision surgery) in order to remove benign gastric lesions and GIST tumors placed in the posterior wall of the stomach or close to the esophagogastric junction or the gastro-duodenal junction. 2. Case Report A 40-year-old woman with a clinical history of persistent epigastric pain was diagnosed by gastroscopy of a gastric submucosal tumor in the esophagogastric junction. Endoscopic ultrasound showed a 20？mm submucosal tumor with benign features. The biopsy performed guided by the endoscopic ultrasound revealed a leiomyoma. The locations of the lesion lead us to perform a laparoscopic