Tumors close to the gastroesophageal junction and those arising on the posterior gastric wall pose a challenge to the laparoscopic surgeon.

This video demonstrates a selection of varied approaches to the submucosal gastric mass which arises in a difficult location.

For lesions originating in the proximal stomach in close proximity to the gastroesophageal junction, a flexible endoscopic-assisted, laparoscopic, transgastric wedge resection can be performed with removal of the tumor per os. Lesions of the posterior gastric wall which are predominantly intraluminal, may be resected through an anterior gastrotomy, laparoscopic wedge resection, and subsequent gastrotomy closure. Smaller lesions of the posterior gastric wall may be simply wedge resected after complete posterior gastric mobilization.

Each of these techniques is briefly reviewed.