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Background: Surgical removal is the only curative therapy for gastrointestinal stromal tumor (GIST). Traditionally, this has been achieved by open surgery. Since the last decade, laparoscopic resection of gastric GISTs is a widely accepted technique for these lesions with proven feasibility and safety with advantages of faster recovery, less postoperative pain, better cosmesis and shorter hospital stay. Despite these advantages, the laparoscopic wedge resection has limitations: GISTs, especially located at the posterior wall or near the esophagogastric junction or near the pyloric ring, are more difficult. Intragastric wedge resection, which offers a direct visualization of the tumor during resection, may be beneficial in these cases. We present our experience where a singleincision transgastric resection of gastric GIST was performed with the single incision laparoscopic surgery (SILS) port placed through the anterior wall of the stomach. This technique opens a new field for development of transgastric SILS device. Introduction: For treatment of GISTs located at unreachable areas, such as esophagogastric junction or pyloric ring, laparoscopic resection cannot be applied easily. We used SILS for intragastric resection of GISTs. Materials and Methods: We report three cases of SILS for GIST of the stomach with the SILS port placed intragastric through the anterior wall of the stomach. A skin incision of only 2.5 cm was made to perform this intervention (Figure). Results: Mean age was 68.1 years (range, 53-86). Mean operative time was 74.6 minutes (range, 67-82). No intra-operative complications occurred. No conversion was needed. All patients healed without any complication. Re-alimentation was started on the third postoperative day. Mean postoperative stay was 5 days (range, 4-6). Mean size was 3.8 cm (range, 2.7-6.8). Discussion: Single-incision laparoscopic intragastric resection for treatment of GISTs located at unreachable areas, such as esophagogastric junction or pyloric ring, is a safe and feasible procedure allowing direct visualization of the lesion and better control of the surgical margin. This intragastric SILS technique offers a new field for development of SILS and further research progress in oncologic surgery.

Gastrointestinal stromal tumors (GISTs) are rare mesenchymal smooth muscle neoplasms that can arise anywhere within the gastrointestinal tract. Approximately 60-70% are located in the stomach. Once considered variants of smooth muscle tumors, they are now understood as originating from the interstitial cells of Cajal or their stem cell precursors. The majority of GISTs (approximately 95%) express the CD117 antigen (KIT), a proto-oncogene product; 85-95% of these neoplasms have mutations in the c-KIT gene; only 5-7% has mutations in platelet-derived-growth factor alpha (PDGFR alpha). GISTs can be asymptomatic and incidentally found during examination for other pathologies or at autopsy. The most common symptoms of gastric GIST are abdominal pain and bleeding. Diagnostic work up consists of endoscopy with ultrasonography and cross-sectional imaging studies (computed tomography and/or magnetic resonance imaging). Surgery remains the first-line treatment for localized gastric GISTs. Both open and laparoscopic operations have been shown to reduce recurrence rates and improve long-term survival. The use of small-molecule selective tyrosine kinase receptor inhibitors has revolutionized the treatment of advanced GISTs.