Laparoscopic Excision of a Giant Gastric GIST with Stomach Reconstruction

Aaron M Lipskar, MD, Christina L Cheng, Barry A Salky, MD. Division of Minimally Invasive Surgery, Department of General Surgery, The Mount Sinai Hospital; Robert Wood Johnson Medical School, UMDNJ

We present a video demonstrating a laparoscopic excision of a giant gastric gastrointestinal stromal tumor with stomach reconstruction. The patient is a 50-year-old female without significant past medical history who presented with a one month history of fullness of the upper abdomen. Work-up included ultrasound, CAT scan, and esophagogastroduodenoscopy with endoscopic ultrasound that revealed a 5×10 centimeter mass arising from the lesser curvature of the stomach. Cytology from a FNA biopsy was consistent with a stromal tumor. The patient underwent laparoscopic excision. The tumor was easily identified coming off of the lesser curvature of the stomach. It was dissected laterally using a handheld ultrasonic scalpel from the gastrohepatic ligament. The left gastric artery was ligated during the mobilization. Once the lesion was free laterally and posteriorly, a gastrotomy was made with the ultrasonic scalpel and the tumor was excised completely. The lesser curvature was reconstructed with a running 2-0 Vicryl. Upper endoscopy was performed intraoperatively, revealing no evidence of leak, bleeding, or obstruction. The specimen was removed through a Pfannenstiel incision. Pathology revealed a 9x7x5 centimeter gastrointestinal stromal tumor with necrotic debris in the center. The tumor cells were positive for c-kit and CD34 and the mitotic rate was 3 per 50 high power fields, thus qualifying as having low malignant potential. The patient tolerated the procedure well. An upper GI fluoroscopic study on postoperative day 1 revealed no evidence of leak or obstruction. She was discharged from the hospital on postoperative day 2.

Session: VidTV2
Program Number: V072

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