内镜辅助下腮腺浅叶部分切除术与传统腮腺浅叶部分切除术的比较研究

Objective To investigate the feasibility of endoscopy-assisted partial-superficial parotidectomy. Methods 38 cases with benign tumors located in the superficial lobe of the parotid gland were randomly assigned to receive conventional (20 cases) or endoscopic (18 cases) partial-superficial paretidectomy. Two short incisions, which were 2 ～ 2.5 cm in length and located at retromandibular and postauricular area, were adopted for endoscopy-assisted surgery. The facial nerve was dissected through retrograde approach. Results The tumors were successfidly resected with endoscopy in 18 cases. The operation time was not significantly different between the conventional and endoscopy-assisted procedures (P > 0.05). The intraoperative blood loss was markedly lower in endoscopy-assisted group, compared with conventional group(P < 0.01). All the 18 cases with endoscopy-assisted surgery were satisfactory with the postoperative cosmetic results. The great auricular nerve was preserved very well in 12 patients(66.6%). Transcient facial paralysis happened in 1 ease and relieved 1 months later. Salivary fistula occurred in 1 case and recovered after dressing with pressure for 2 weeks. All the patients were followed up for 24 ～ 50 months (mean, 39 months) without relapse. Conclusions Endoscopy-assisted partial-superficial parotidectomy can successfully treat benign tumors located in the superficial lobe of parotid gland with a better postoperative cosmetic result.     

内镜辅助下腮腺浅叶部分切除术与传统腮腺浅叶部分切除术的比较研究

Objective To investigate the feasibility of endoscopy-assisted partial-superficial parotidectomy. Methods 38 cases with benign tumors located in the superficial lobe of the parotid gland were randomly assigned to receive conventional (20 cases) or endoscopic (18 cases) partial-superficial paretidectomy. Two short incisions, which were 2 ～ 2.5 cm in length and located at retromandibular and postauricular area, were adopted for endoscopy-assisted surgery. The facial nerve was dissected through retrograde approach. Results The tumors were successfidly resected with endoscopy in 18 cases. The operation time was not significantly different between the conventional and endoscopy-assisted procedures (P > 0.05). The intraoperative blood loss was markedly lower in endoscopy-assisted group, compared with conventional group(P < 0.01). All the 18 cases with endoscopy-assisted surgery were satisfactory with the postoperative cosmetic results. The great auricular nerve was preserved very well in 12 patients(66.6%). Transcient facial paralysis happened in 1 ease and relieved 1 months later. Salivary fistula occurred in 1 case and recovered after dressing with pressure for 2 weeks. All the patients were followed up for 24 ～ 50 months (mean, 39 months) without relapse. Conclusions Endoscopy-assisted partial-superficial parotidectomy can successfully treat benign tumors located in the superficial lobe of parotid gland with a better postoperative cosmetic result.     

内镜辅助下腮腺浅叶部分切除术与传统腮腺浅叶部分切除术的比较研究

Objective To investigate the feasibility of endoscopy-assisted partial-superficial parotidectomy. Methods 38 cases with benign tumors located in the superficial lobe of the parotid gland were randomly assigned to receive conventional (20 cases) or endoscopic (18 cases) partial-superficial paretidectomy. Two short incisions, which were 2 ～ 2.5 cm in length and located at retromandibular and postauricular area, were adopted for endoscopy-assisted surgery. The facial nerve was dissected through retrograde approach. Results The tumors were successfidly resected with endoscopy in 18 cases. The operation time was not significantly different between the conventional and endoscopy-assisted procedures (P > 0.05). The intraoperative blood loss was markedly lower in endoscopy-assisted group, compared with conventional group(P < 0.01). All the 18 cases with endoscopy-assisted surgery were satisfactory with the postoperative cosmetic results. The great auricular nerve was preserved very well in 12 patients(66.6%). Transcient facial paralysis happened in 1 ease and relieved 1 months later. Salivary fistula occurred in 1 case and recovered after dressing with pressure for 2 weeks. All the patients were followed up for 24 ～ 50 months (mean, 39 months) without relapse. Conclusions Endoscopy-assisted partial-superficial parotidectomy can successfully treat benign tumors located in the superficial lobe of parotid gland with a better postoperative cosmetic result.     

内镜辅助下腮腺浅叶部分切除术与传统腮腺浅叶部分切除术的比较研究

Objective To investigate the feasibility of endoscopy-assisted partial-superficial parotidectomy. Methods 38 cases with benign tumors located in the superficial lobe of the parotid gland were randomly assigned to receive conventional (20 cases) or endoscopic (18 cases) partial-superficial paretidectomy. Two short incisions, which were 2 ～ 2.5 cm in length and located at retromandibular and postauricular area, were adopted for endoscopy-assisted surgery. The facial nerve was dissected through retrograde approach. Results The tumors were successfidly resected with endoscopy in 18 cases. The operation time was not significantly different between the conventional and endoscopy-assisted procedures (P > 0.05). The intraoperative blood loss was markedly lower in endoscopy-assisted group, compared with conventional group(P < 0.01). All the 18 cases with endoscopy-assisted surgery were satisfactory with the postoperative cosmetic results. The great auricular nerve was preserved very well in 12 patients(66.6%). Transcient facial paralysis happened in 1 ease and relieved 1 months later. Salivary fistula occurred in 1 case and recovered after dressing with pressure for 2 weeks. All the patients were followed up for 24 ～ 50 months (mean, 39 months) without relapse. Conclusions Endoscopy-assisted partial-superficial parotidectomy can successfully treat benign tumors located in the superficial lobe of parotid gland with a better postoperative cosmetic result.     

内镜辅助下腮腺浅叶部分切除术与传统腮腺浅叶部分切除术的比较研究

Objective To investigate the feasibility of endoscopy-assisted partial-superficial parotidectomy. Methods 38 cases with benign tumors located in the superficial lobe of the parotid gland were randomly assigned to receive conventional (20 cases) or endoscopic (18 cases) partial-superficial paretidectomy. Two short incisions, which were 2 ～ 2.5 cm in length and located at retromandibular and postauricular area, were adopted for endoscopy-assisted surgery. The facial nerve was dissected through retrograde approach. Results The tumors were successfidly resected with endoscopy in 18 cases. The operation time was not significantly different between the conventional and endoscopy-assisted procedures (P > 0.05). The intraoperative blood loss was markedly lower in endoscopy-assisted group, compared with conventional group(P < 0.01). All the 18 cases with endoscopy-assisted surgery were satisfactory with the postoperative cosmetic results. The great auricular nerve was preserved very well in 12 patients(66.6%). Transcient facial paralysis happened in 1 ease and relieved 1 months later. Salivary fistula occurred in 1 case and recovered after dressing with pressure for 2 weeks. All the patients were followed up for 24 ～ 50 months (mean, 39 months) without relapse. Conclusions Endoscopy-assisted partial-superficial parotidectomy can successfully treat benign tumors located in the superficial lobe of parotid gland with a better postoperative cosmetic result.     

内镜辅助下腮腺浅叶部分切除术与传统腮腺浅叶部分切除术的比较研究

Objective To investigate the feasibility of endoscopy-assisted partial-superficial parotidectomy. Methods 38 cases with benign tumors located in the superficial lobe of the parotid gland were randomly assigned to receive conventional (20 cases) or endoscopic (18 cases) partial-superficial paretidectomy. Two short incisions, which were 2 ～ 2.5 cm in length and located at retromandibular and postauricular area, were adopted for endoscopy-assisted surgery. The facial nerve was dissected through retrograde approach. Results The tumors were successfidly resected with endoscopy in 18 cases. The operation time was not significantly different between the conventional and endoscopy-assisted procedures (P > 0.05). The intraoperative blood loss was markedly lower in endoscopy-assisted group, compared with conventional group(P < 0.01). All the 18 cases with endoscopy-assisted surgery were satisfactory with the postoperative cosmetic results. The great auricular nerve was preserved very well in 12 patients(66.6%). Transcient facial paralysis happened in 1 ease and relieved 1 months later. Salivary fistula occurred in 1 case and recovered after dressing with pressure for 2 weeks. All the patients were followed up for 24 ～ 50 months (mean, 39 months) without relapse. Conclusions Endoscopy-assisted partial-superficial parotidectomy can successfully treat benign tumors located in the superficial lobe of parotid gland with a better postoperative cosmetic result.     

内镜辅助下腮腺浅叶部分切除术与传统腮腺浅叶部分切除术的比较研究

Objective To investigate the feasibility of endoscopy-assisted partial-superficial parotidectomy. Methods 38 cases with benign tumors located in the superficial lobe of the parotid gland were randomly assigned to receive conventional (20 cases) or endoscopic (18 cases) partial-superficial paretidectomy. Two short incisions, which were 2 ～ 2.5 cm in length and located at retromandibular and postauricular area, were adopted for endoscopy-assisted surgery. The facial nerve was dissected through retrograde approach. Results The tumors were successfidly resected with endoscopy in 18 cases. The operation time was not significantly different between the conventional and endoscopy-assisted procedures (P > 0.05). The intraoperative blood loss was markedly lower in endoscopy-assisted group, compared with conventional group(P < 0.01). All the 18 cases with endoscopy-assisted surgery were satisfactory with the postoperative cosmetic results. The great auricular nerve was preserved very well in 12 patients(66.6%). Transcient facial paralysis happened in 1 ease and relieved 1 months later. Salivary fistula occurred in 1 case and recovered after dressing with pressure for 2 weeks. All the patients were followed up for 24 ～ 50 months (mean, 39 months) without relapse. Conclusions Endoscopy-assisted partial-superficial parotidectomy can successfully treat benign tumors located in the superficial lobe of parotid gland with a better postoperative cosmetic result.     

内镜辅助下腮腺浅叶部分切除术与传统腮腺浅叶部分切除术的比较研究

Objective To investigate the feasibility of endoscopy-assisted partial-superficial parotidectomy. Methods 38 cases with benign tumors located in the superficial lobe of the parotid gland were randomly assigned to receive conventional (20 cases) or endoscopic (18 cases) partial-superficial paretidectomy. Two short incisions, which were 2 ～ 2.5 cm in length and located at retromandibular and postauricular area, were adopted for endoscopy-assisted surgery. The facial nerve was dissected through retrograde approach. Results The tumors were successfidly resected with endoscopy in 18 cases. The operation time was not significantly different between the conventional and endoscopy-assisted procedures (P > 0.05). The intraoperative blood loss was markedly lower in endoscopy-assisted group, compared with conventional group(P < 0.01). All the 18 cases with endoscopy-assisted surgery were satisfactory with the postoperative cosmetic results. The great auricular nerve was preserved very well in 12 patients(66.6%). Transcient facial paralysis happened in 1 ease and relieved 1 months later. Salivary fistula occurred in 1 case and recovered after dressing with pressure for 2 weeks. All the patients were followed up for 24 ～ 50 months (mean, 39 months) without relapse. Conclusions Endoscopy-assisted partial-superficial parotidectomy can successfully treat benign tumors located in the superficial lobe of parotid gland with a better postoperative cosmetic result.     

内镜辅助下腮腺浅叶部分切除术与传统腮腺浅叶部分切除术的比较研究

Objective To investigate the feasibility of endoscopy-assisted partial-superficial parotidectomy. Methods 38 cases with benign tumors located in the superficial lobe of the parotid gland were randomly assigned to receive conventional (20 cases) or endoscopic (18 cases) partial-superficial paretidectomy. Two short incisions, which were 2 ～ 2.5 cm in length and located at retromandibular and postauricular area, were adopted for endoscopy-assisted surgery. The facial nerve was dissected through retrograde approach. Results The tumors were successfidly resected with endoscopy in 18 cases. The operation time was not significantly different between the conventional and endoscopy-assisted procedures (P > 0.05). The intraoperative blood loss was markedly lower in endoscopy-assisted group, compared with conventional group(P < 0.01). All the 18 cases with endoscopy-assisted surgery were satisfactory with the postoperative cosmetic results. The great auricular nerve was preserved very well in 12 patients(66.6%). Transcient facial paralysis happened in 1 ease and relieved 1 months later. Salivary fistula occurred in 1 case and recovered after dressing with pressure for 2 weeks. All the patients were followed up for 24 ～ 50 months (mean, 39 months) without relapse. Conclusions Endoscopy-assisted partial-superficial parotidectomy can successfully treat benign tumors located in the superficial lobe of parotid gland with a better postoperative cosmetic result.     

内镜辅助下腮腺浅叶部分切除术与传统腮腺浅叶部分切除术的比较研究

Objective To investigate the feasibility of endoscopy-assisted partial-superficial parotidectomy. Methods 38 cases with benign tumors located in the superficial lobe of the parotid gland were randomly assigned to receive conventional (20 cases) or endoscopic (18 cases) partial-superficial paretidectomy. Two short incisions, which were 2 ～ 2.5 cm in length and located at retromandibular and postauricular area, were adopted for endoscopy-assisted surgery. The facial nerve was dissected through retrograde approach. Results The tumors were successfidly resected with endoscopy in 18 cases. The operation time was not significantly different between the conventional and endoscopy-assisted procedures (P > 0.05). The intraoperative blood loss was markedly lower in endoscopy-assisted group, compared with conventional group(P < 0.01). All the 18 cases with endoscopy-assisted surgery were satisfactory with the postoperative cosmetic results. The great auricular nerve was preserved very well in 12 patients(66.6%). Transcient facial paralysis happened in 1 ease and relieved 1 months later. Salivary fistula occurred in 1 case and recovered after dressing with pressure for 2 weeks. All the patients were followed up for 24 ～ 50 months (mean, 39 months) without relapse. Conclusions Endoscopy-assisted partial-superficial parotidectomy can successfully treat benign tumors located in the superficial lobe of parotid gland with a better postoperative cosmetic result.     

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内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)作为一种治疗早期胃癌新技术,同样适用于治疗食管胃结合部(esophagogastric junction,EGJ)的浅表癌。ESD治疗食管胃结合部腺癌(adenocarcinoma of the esophagogastric junction,AEG)及EGJ处癌前病变,与外科剖腹手术及内镜黏膜切除术(endoscopic mucosal resection,EMR)等内镜治疗方法相比,具有明显优势。但ESD治疗EGJ处病变,手术难度较高,手术时间更长,手术并发症发生率更高,对操作者的技术要求较高。     

Laparoscopic intragastric stapled resection of gastric submucosal tumors located near the esophagogastric junction

BACKGROUND: Laparoscopic resection cannot be applied easily to tumors located near the esophagogastric junction or the pyloric ring. We evaluated our laparoscopic intragastric surgical technique for gastric submucosal tumors located near the esophagogastric junction and the results of a clinical study. MATERIALS AND METHODS: We performed our technique in six patients: one man and five woman with a mean age of 61 years. Using the laparoscopic procedure, after inflation of the stomach, we inserted two or three balloon-type ports into the stomach through the abdominal wall. RESULTS: A stapled resection of gastric submucosal tumors using a laparoscopic linear stapler was performed successfully in all the patients. Without exception, stapled resections were successfully performed. The mean operation time was 168 min, and the blood loss was minimal There were no intra- or postoperative complications. The mean postoperative hospital stay was 9.8 days. The mean maximal diameter size of the resected specimens was 2.4 cm. Histopathologic diagnoses were gastrointestinal stromal tumors in five cases and enterogenous cyst in one. There were no recurrences during a mean follow-up period of 27 +/- 11.6 months. CONCLUSION: Although we need to evaluate the long-term outcomes, our procedure is considered technically feasible, safe, and useful for the resection of gastric submucosal tumors located near the esophagogastric junction.     

Tailored-approach of laparoscopic wedge resection for treatment of submucosal tumor near the esophagogastric junction

Background Laparoscopic wedge resection (LWR) of the stomach cannot easily be applied to tumors that are located near the esophagogastric junction (EGJ). To define the tailored approach for this type of tumors, we evaluated our laparoscopic surgical technique and clinical outcomes. Methods We successfully performed 10 LWRs for patients with submucosal tumor (SMT) located 3 cm or less from the esophagogastric junction. A presumptive diagnosis of gastrointestinal stromal tumor (GIST) was made in all the cases, based on endoscopic and radiologic examinations. The patient demographics, perioperative parameters and outcomes of 10 patients were assessed. Results Neither intraoperative complications nor conversion to open surgery was required, and we were able to perform complete tumor excision with negative surgical margins for all the patients. The laparoscopic approaches of resection included the transgastric method (n = 5) and the exogastric method (n = 5). The mean operation time was 92.5 minutes (range 60–125 minutes). No blood transfusion was given for all cases in the perioperative period. The patients’ oral intake was restored on the third postoperative day. The hospital stay ranged from three to seven days (mean: 4.9 days). Pathologic analysis of the resected specimens showed six GISTs, three leiomyomas, and one lipoma. Conclusions Laparoscopic resection of gastric SMTs located near the EGJ is a feasible and safe procedure. The laparoscopic approaches to this area should be tailored, based on the location, size and expanding pattern of the tumor. This work was supported partly by the Catholic Cancer Center     

内镜下切除技术对食管胃连接部胃肠间质瘤的治疗价值

目的评价以内镜黏膜下剥离术（ESD）为基础的内镜下切除术在食管胃连接部（EGJ）胃肠间质瘤（GIST）治疗中的安全性及有效性。方法收集复旦大学附属中山医院内镜中心所有接受ESD治疗的患者资料．筛选出2007年11月至2011年6月间经病理证实的EGJ处GIST患者20例．总结并分析其临床病理及术后随访资料。结果20例EGJ处GIST均起源于固有肌层,其中男性11例,女性9例,年龄29～67（平均54．1）岁,病灶直径8-20（平均14．8）mm。所有病例均成功完成内镜切除手术．其中15例接受了内镜黏膜下挖除术．4例接受了无腹腔镜辅助的内镜全层切除术。1例接受了内镜经黏膜下隧道肿瘤切除术。手术时间15-90（平均47．8）min,术中出血量5-200ml,病灶的完整切除率为100％。术中穿孔4例,气腹3例,气胸1例,贲门黏膜撕裂1例,均通过内镜下处理及保守治疗恢复。20例患者术后均接受了3-36（平均13-2）个月的随访,无局部复发和远处转移病例。结论在EGJ处GIST的治疗中,以ESD为基础的内镜下切除技术是一种安全和有效的治疗手段。     

Therapie beim Magenkarzinom

In two randomized trials it was demonstrated that preoperative and postoperative chemotherapy shows a statistically significant and clinically relevant improvement in progression-free and overall survival for adenocarcinoma of the esophagogastric junction and stomach when compared with the surgical control arm. The absolute benefit in overall survival was 13% and 14% after 5 years. This benefit is clearly shown for patients with locally advanced tumors but remains debatable in early disease stages. Postoperative mortality and the complication rate were not increased. Based on published study results perioperative chemotherapy has to be regarded as the new standard of care at least for patients staged as uT3/uT4 tumors as defined by endoscopic ultrasound. To date there are no indications for adjuvant chemotherapy or chemoradiation after R0 resection and adequate surgery.     

Individualized surgical strategies for cancer of the esophagogastric junction

Due to their borderline location between the stomach and esophagus the optimal surgical strategy for patients with adenocarcinoma of the esophagogastric junction is controversial. Irrespective of the surgical approach a complete removal of the primary tumor and its lymphatic drainage has to be the primary goal of surgical treatment of such tumors. Based on the experience with surgical resection of more than 1000 patients with adenocarcinoma of the esophagogastric junction we recommend an individualized surgical strategy guided by tumor stage and topographic location of the tumor center or tumor mass. This requires detailed preoperative staging and classification of tumors arising in the vicinity of the esophagogastric junction into adenocarcinoma of the distal esophagus (AEG Type I Tumors), true carcinoma of the gastric cardia (AEG Type II Tumors) and subcardial gastric carcinoma infiltrating the esophagogastric junction (AEG Type III Tumors). In patients with Type I Tumors transthoracic esophagectomy offers no survival benefit over radical transmediastinal esophagectomy, but is associated with higher morbidity. In patients with Type II or Type III tumors an extended total gastrectomy results in equal or superior survival and less postoperative mortality than a more extended esophagogastrectomy. In patients with early tumors, staged as uT1 on preoperative endosonography, a limited resection of the proximal stomach, cardia and distal esophagus with interposition of a pedicled isoperistaltic jejunal segment allows a complete tumor removal with adequate lymphadenectomy and offers excellent functional results. Multimodal treatment protocols with neoadjuvant chemotherapy or combined radiochemotherapy followed by surgical resection appear to markedly improve the prognosis in patients with locally advanced tumors who respond to preoperative treatment. With this tailored approach extensive preoperative staging becomes mandatory for an adequate selection of the appropriate therapeutic concept.     

Laparoscopic enucleation or wedge resection of benign gastric pathology: analysis of 44 consecutive cases

Laparoscopic resection of gastric submucosal tumors has been described, but the role of laparoscopy for tumors within the esophagus or near the gastroesophageal junction is not clearly defined. The aim of this study was to examine the outcomes of laparoscopic or thoracoscopic enucleation or wedge resection of benign gastric tumors. The charts of 44 patients who underwent minimally invasive resection of benign esophagogastric tumors were reviewed. Surgical approaches included thoracoscopic enucleation (n = 2), laparoscopic enucleation (n = 6), transgastric enucleation (n = 2), and laparoscopic gastric wedge resection (n = 34). There were 23 males with a mean age of 57 years. There was one conversion (2.5%) to laparotomy. Mean operative time was 97 ± 52 minutes. The mean length of hospital stay was 2.6 ± 2.0 days. One patient developed gastric outlet obstruction requiring Roux-en-Y reconstruction. There were no leaks and the 90-day mortality was zero. Pathology demonstrated gastrointestinal stromal tumor (n = 31), leiomyoma (n = 6), and other benign pathology (n = 7). There has been one tumor recurrence at a mean follow-up of 4.3 years. The laparoscopic approaches to local resection of gastric tumors are safe and feasible. The type of minimally invasive surgical approaches should be tailored based on the location and size of the lesion.     

Laparoscopic surgery for submucosal tumors located at the esophagogastric junction and the prepylorus

Background  Laparoscopic partial gastric resection is widely accepted as a treatment for gastric submucosal tumors (SMTs). However, SMTs of either end of the stomach are generally managed by subtotal gastrectomies or total gastrectomies. This study was conducted to evaluate surgical techniques for management of SMTs located at the ends of the stomach. Methods  Among 63 patients who were diagnosed and underwent laparoscopic surgery for gastric SMTs at Seoul National University Bundang Hospital from May 2003 to May 2007, 11 SMTs located at the ends of the stomach were identified. The clinicopathologic results of these 11 SMTs were analyzed. Results  Laparoscopic partial wedge resections or tumor excisions were successfully performed on all patients except for those who had prepyloric tumors. Six men and five women had SMTs at the ends of the stomach. The patients ranged in age from 21–63 years (mean 43.4 ± 13.5 years). Of six esophagogastric junctional tumors that showed low, homogeneous contrast enhancement on computed tomography (CT) scans, five were treated by laparoscopic transgastric enucleation and one by tumor-everting resection. One esophagogastric junctional tumor that leaned toward the fundus and showed a 6-cm-diameter endophytic mass with heterogeneous enhancement on CT scan was resected by laparoscopic wedge resection. The mean operation time was 100 min (range 60–210 min). Three laparoscopy-assisted distal gastrectomies and one laparoscopic wedge resection were performed on SMTs located near the prepyloric antrum. There were no intra- or postoperative complications. Duration of postoperative hospital stay ranged from 4–7 days. Conclusion  Laparoscopic local resection is an effective treatment for SMTs located at the esophagogastric junction and can be used instead of a total or proximal gastrectomy. However, gastrectomies should be considered for SMTs located near the pylorus because of the small volume of the lower third of the stomach.     

Cardiac tamponade as a life-threatening complication in antireflux surgery

BACKGROUND: While injuries to the esophagus, stomach, spleen and pleura are well-known, cardiac lesions resulting from complications of surgery at the esophagogastric junction are rarely reported in the literature. METHODS: We report on two of our own patients with cardiac tamponade after surgery at the esophagogastric junction and present a review of the literature. RESULTS: We overview seven patients (including our own). In five cases a stitch to the diaphragm was the cause. The lesions became apparent during and up to fourteen days after the operation. In three cases the complication led to death. CONCLUSIONS: It is essential to consider the risk of cardiac lesions with surgery at the esophagogastric junction, especially if sutures or staples are placed in this region. Only with an appropriate alertness and management can this complication be prevented and its potentially fatal issue averted.     

Laparoscopic transgastric tumor-everting resection of the gastric submucosal tumor located near the esophagogastric junction

Local resection of the stomach is suitable for the treatment of submucosal tumors (SMT). However, it cannot be easily performed laparoscopically on tumors located near the esophagogastric junction. We have developed a new technique, which is called transgastric tumor-everting resection. To identify the location of the SMT laparoscopically without an oral endoscope, an Indiana ink mark was made prior to the operation. The SMT was everted from the gastrotomy and held by the Mini Loop Retractor II. The gastric mucosa could be observed from gastrotomy, allowing us to confirm that the staple line would not cause deformity of the esophagogastric junction. The lesion was then resected, and the gastrotomy was closed simultaneously using the Endo-GIA Universal. This technique is easy, safe, and useful for the laparoscopic resection of gastric SMTs located on the greater curvature or anterior wall of the fornix, near the esophagogastric junction.