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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 hand-assisted 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 The intact spesimen was withdrawn through the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.
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