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.