Laparoscopic Intragastric Surgery (LIGS): How I Do It

Laparoscopic intragastric surgery (LIGS) represents a minimally invasive technique that may be used for the surgical treatment of gastric lessions that cannot be solved by endoscopy. The technique assume to work with laparoscopic trocars directly into the stomach by respecting the same principles of basic laparoscopy, such as CO2 insufflation to create an intragastric operating space, introduction of surgical instruments through working ports and the use of different surgical approaches. We present a case of LIGS performed by Dr. Lucian Mocan at 3-rd Surgical Clinic Cluj Napoca, Romania. In this demonstrative video we describe the technical principles of this new approach that may represent a step forward for the management of gastric tumors and early cancers since is able to avoid major surgical procedures with high risk for the patient. LIGS technique also has the advantage that keeps the normal anatomy and the recovery of the patient is very fast. A 55-year-old male presented to the EU with a one-day history of haemetemesis with coffee ground vomiting. He did not have a history of alcoholic consumption, chronic liver disease or peptic disease. After initial resuscitation, he underwent upper GI endoscopy under sedation which demonstrated large clots in the stomach along with a bleeding, gastric submucosal mobile mass located in antrum. This hemorrhage was then controlled with the use of adrenaline injection and argon plasma coagulation. After blood transfusion and plasma administration the patient maintained stable. In this context a laparoscopic intragastric surgery was planned to safely resect the tumor. Histopathology of the tumor revealed a 2 × 3.4 × 3.2 cm sized neoplasm arising from the gastric submucosa composed of fusiform and epitheloid cells. Immunohistochemistry reported that the tumor cells were positive for vimentin, and desmin. The findings favored the diagnosis of epitheloid gastrointestinal stromal tumor of low malignant potential. The resected specimen showed clear margins.