0033 Endo Video
HAND-ASSISTED LAPAROSCOPIC WEDGE RESECTION FOR
LARGE POSTERIOR GASTRIC STROMAL TUMOR (GST):
A CASE REPORT
O. Avrutis, O. Sibirsky, J. Meshoulam, A. Durst
Department of Surgery, Bikur Cholim Hospital, Jerusalem
Background: Because nodal involvement is extremely rare, surgery for GST
consists of wedge excision with clear resection margins. Since 1992, when
local excision of GST via laparoscopic approach was first described, only a
few case reports and small series have been published.
Case report: A 60-year-old obese (BMI= 41) woman was referred to our
unit with the diagnosis of a gastric tumor. Abdominal CT revealed 8x12x14
cm mobile tumor of the posterior gastric wall. The diagnosis of submucosal
GST was confirmed by endoscopic ultrasonography. Two 12-mm trocars
laparoscopy using hand-assisted technique was undertaken. The handassisted device (LapDisk, Hakko, Japan) was inserted into the abdomen
through 7.5-cm low midline incision. The large mobile tumor originated
from the posterior gastric wall close to the greater curvature was found to
occupy the entire lesser sac. The gastrosplenic and gastrocolic ligaments
were opened wide, and the adhesions between the tumor and surrounding
structures were divided using laparosonic coagulating shears (LCS,
Ethicon). Wedge resection of the gastric wall was performed with linear
stapler (EndoGIA-30, Ethicon), maitaning a safe margins from the tumor.
The intact spesimen was withdrawn through the hand-assist wound. The
presented Video demonstrates the details of the procedure. The surgery took
130 minutes. Postoperative recovery was uneventful. Oral feeding was
started on postoperative day 4. The sections showed GST with low risk of
being malignant.