Laparoscopic wedge resection for a stromal gastric tumor

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Laparoscopic wedge resection for a stromal gastric tumor

Authors

J Leroy, J Marescaux

Media type

Surgical video

Duration

03'00''

Publication

2005-10

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E-publication

WeBSurg.com, Oct 2005;5(10).
URL: http://www.websurg.com/doi-vd01en1703.htm

Laparoscopic wedge resection for a stromal gastric tumor

1. Case description 00'10''

This is the case history of a female patient presenting with anorexia, lack of appetite and weight loss. Upon evaluation of the patient, MRI studies show the presence of a gastric wall lesion 3cm in diameter consistent with leiomyoma. A biopsy revealed the presence of a subserosal stromal tumor with smooth muscle cell differentiated suspicion for benign process.

2. Trocar placement 00'39''

This will be the optic port. Two 5mm ports will be utilized for retraction. One final port is for introduction of the Ligasure and GIA devices. A pneumoperitoneum is obtained using the open technique 10cm from the costal margin in the left mid-clavicular line.

3. Tumor dissection 01'00''

The patient had an open cholecystectomy performed previously and adhesions are appreciated secondary to this. Adhesiolysis is performed along the suture line. Exploration of the abdominal cavity and of the gastric lesion is noted. A pedunculated tumoral mass is identified. As this mass is noted to be on the lesser curvature, there is a decreased incidence of malignant process and an Endostitch is placed to aid in this mobilization. The Ligasure device is used in the dissection above the lesser curvature. We find this device extremely useful in sealing vessels up to 6, 7mm as is the case above the antrum.

4. Tumor resection 02'20''

A GIA device is then advanced through the left subcostal port and fired sequentially across the base of the tumor. The tumor is then set aside and additional exploration above the antrum is then completed. Upon noting the hemostasis along the staple line.

5. Extraction of specimen 02'56''

The tumor is placed in an Endocatch bag and removed from the left subcostal port.