Background: Recent advances in minimally invasive surgery have included methods for reducing the number of incisions for trocar placement. Single Port Access is a novel method allowing the performance of standard laparoscopic procedures through one incision. We have applied Single Port Access (SPA) surgery to procedures of the gastroesophageal (GE) junction through a single skin incision, usually placed within the umbilicus. We report the first Single Port Access resection of a proximal 3cm x 3cm GIST tumor in a patient presenting with an upper gastrointestinal bleed.
Methods: Entry into the abdomen was achieved through an 18-mm umbilical incision for placement of a 5-mm trocar for the laparoscope. Skin flaps were subsequently created lateral to the laparoscope for placement of 2 additional trocars for the dissecting instruments. Once the single-port access had been achieved, the dissection of the mass was carried out with the collaboration of the gastroenterologist who performed an upper endoscopy, aiding in the eversion and dissection of the mass and evaluating the gastric resection site intraluminally. The mass was removed successfully, and no intraoperative and postoperative complications occurred.
Conclusion: This is our first GIST resection done via a combined NOTES/Single Port Access approach. The principles for laparoscopic dissection and resection of the GIST tumor performed via the single-port access approach remain the same as standard multi-port laparoscopy.
Authors: Andrew S. Wu, MD, Nithin Karanth, MD, Paul G. Curcillo II, MD