An analysis of endoscopy-assisted and laparoscopic intragastric surgery in an experimental model of gastric submucosal pseudotumor

Objective: This study aimed to evaluate the feasibility and usefulness of the combination of flexible endoscopy and laparoscopy during minimally invasive intragastric treatment of experimental submucosal pseudotumors located at the level of Z-line.

Methods and procedures: Six healthy female pigs urderwent a transparietal injection of sterile alginate at the level of Z-line area creating a model of gastric submucosal pseudotumor The operative procedures included intragastric surgery with endoscopic vision (n ((equals)) 3) and intragastric surgery with gastrotomy and laparoscopic vision (n ((equals)) 3), using a two mini? laparoscopic portals or single-port technique, respectively. The pseudotumors were resected and the gastric mucosal layer was closed using intracorporeal sutures. The gastrotomy and the minilaparotomy were closed in a multilayered fashion.

Results: The pseudotumors ranged in size from 3 to 6 cm in diameter. The access of the intragastric cavity was successfully performed in all animals without complications. The transgastric approaches were performed without any complication in all animals. More technical difficulties were encountered in the transgastric approach with endoscopic vision. The duration of the operations ranged from 70 to 130 mins. No complications were encountered on the postoperative follow-up. After one-month exploratory laparotomy not showed alterations in abdominal cavity.

Conclusions: This experiment showed the usefulness of porcine model for research in minimally invasive intragastric surgery. The application of transgastric endoscopic-assisted and laparoscopic surgery to submucosal pseudotumor of the stomach are technically feasible, safe and reproducible and may be an useful alternative to open surgery and endoscopic techniques. Additional studies will be necessary to establish the role of transgastric surgery in the treatment of gastric cancer.