J Min Access Surg Close
 

Figure 1: Gastrointestinal stromal tumour juxta-gastroesophageal junction visualised on upper endoscopy (a) and on computer tomography (b). (c) A patient in supine position. Standard foregut ports are placed with 8-mm camera port 12 cm below the xiphoid process and 2 cm to the left of the midline. Additional left and right 8-mm ports are placed in the respective midclavicular line under direct visualisation. (d) Intraoperative endoscopy to visually confirm the lesion with reference to its location with gastroesophageal junction or lesser curvature. (e) Under direct visualisation 3 mg of indocyanine green is injected into the lesion at four quadrants. (f) Using firefly mode, the lesion stands out as a well-demarcated green fluorescent region of interest. Targeted gastrotomy is made (g), and the lesion can then be easily everted and resected with gross negative margins using robotic endoshears (h). (i) Gastrotomy is closed in layers, first closure is approximation of the inner mucosal edges using absorbable suture, and finally, the anterior gastrotomy is closed in two layers

Figure 1: Gastrointestinal stromal tumour juxta-gastroesophageal junction visualised on upper endoscopy (a) and on computer tomography (b). (c) A patient in supine position. Standard foregut ports are placed with 8-mm camera port 12 cm below the xiphoid process and 2 cm to the left of the midline. Additional left and right 8-mm ports are placed in the respective midclavicular line under direct visualisation. (d) Intraoperative endoscopy to visually confirm the lesion with reference to its location with gastroesophageal junction or lesser curvature. (e) Under direct visualisation 3 mg of indocyanine green is injected into the lesion at four quadrants. (f) Using firefly mode, the lesion stands out as a well-demarcated green fluorescent region of interest. Targeted gastrotomy is made (g), and the lesion can then be easily everted and resected with gross negative margins using robotic endoshears (h). (i) Gastrotomy is closed in layers, first closure is approximation of the inner mucosal edges using absorbable suture, and finally, the anterior gastrotomy is closed in two layers