Single port sleeve gastric resection for a GIST

Single Port Surgery is an advanced minimally invasive approach leaving almost no visible scar. With this technique, pain and discomfort are also reduced to a minimum and recovery time is quicker. This video demonstrates a laparoscopic single port sleeve gastric resection in a 41-year-old female patient who presented with weight loss and was found to have a gastrointestinal stromal tumor (GIST) arising from the posterior wall of the proximal stomach.

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Single port sleeve gastric resection for a GIST

Authors

B Alkari, I Ahmed

Abstract

Single Port Surgery is an advanced minimally invasive approach leaving almost no visible scar. With this technique, pain and discomfort are also reduced to a minimum and recovery time is quicker. This video demonstrates a laparoscopic single port sleeve gastric resection in a 41-year-old female patient who presented with weight loss and was found to have a gastrointestinal stromal tumor (GIST) arising from the posterior wall of the proximal stomach.

Classification

new techniques, single port, contribution

Keywords

Single port sleeve gastric resection for a GIST

Media type

Surgical video

Duration

05'26''

Publication

2010-01

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E-publication

WeBSurg.com, Jan 2010;10(01).
URL: http://www.websurg.com/doi-vd01en2850.htm

Single port sleeve gastric resection for a GIST

1. Introduction 00'10''

This video demonstrates a laparoscopic single port sleeve gastric resection in a 41-year-old female patient who presented with weight loss and was found to have a gastrointestinal stromal tumor (GIST) arising from the posterior wall of the proximal stomach.

2. Patient positioning and port insertion 00'23''

The patient was positioned in the modified Lloyd-Davis position. A 1.5cm cutdown incision was made through the umbilical scar with the fascial defect widened to 2cm to facilitate the insertion of a lubricated Covidien 5mm SILS port. Three 5mm ports were inserted and positioned in a staggered fashion to reduce instrument clashing. The capnoperitoneum was established maintaining the pressure at 12mmHg, and a 5mm, 30 degree camera was inserted.

3. Inspection, evaluation and retraction of the stomach 00'52''

Inspection of the peritoneal cavity and palpation of the stomach was facilitated by the use of a combination of straight and roticulating graspers, which also allowed retraction of the splenic flexure of the colon to identify the tumor location by the presence of a hypervascular area close to the greater curvature of the stomach. Two 2/0 Polydioxanone sutures (PDS II, Ethicon) on straight needles through the abdominal wall and across the greater curvature of the stomach were used to facilitate anterior displacement of the stomach, exposing the tumor within the lesser sac.

4. Division of gastrocolic omentum 02'27''

The Harmonic® scalpel was used to divide the gastrocolic omentum and gain access to the lesser sac. The tumor was then identified and manipulated with a roticulating grasper to facilitate resection.

5. Gastric transection 03'35''

A 5mm port was replaced by a 12mm port to allow the introduction of an endoscopic stapler. Two firings of the stapler were required to achieve a clear resection margin. A 10mm Endo-catch™ retrieval bag was inserted and the specimen manipulated inside it. The bag was closed, and the peritoneal cavity inspected to confirm hemostasis.

6. Specimen extraction 04'16''

The bag was then extracted together with the port and the port site was closed leaving minimum obvious scarring within the umbilicus. The patient was discharged within 24 hours from surgery. Subsequent histopathological analysis confirmed the lesion to be a completely resected GIST tumor.