• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2022
      • SAGES 2021
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy-Coming Soon!
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • “Unofficial” Logo Products
  • Log In

Laparoscopic subtotal gastrectomy and left adrenalectomy for large gastric GIST with left adrenal incidentaloma in an obese patient

Hariruk Yodying, MD. Department of surgery, HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC) Hospital, Srinakharinwirot University

BACKGROUND: Laparoscopic resection has become an accepted treatment for small Gastrointestinal stromal tumors (GISTs) of the stomach, but its application for large GISTs exceeding 5 cm. remains controversial. Because of the advancements in laparoscopic surgical techniques, the combination of different surgical procedures in a single operation has been widely reported. We present our experience of simultaneous laparoscopic resection for large gastric GIST with left adrenal incidentaloma in an obese patient.

CASE PRESENTATION: A 75-year-old female patient with BMI of 31 kg/m2 presented with dyspepsia for 3 months. The abdominal ultrasounds showed a heterogeneous mass at epigastrium and nodule at left adrenal gland. Contrast-enhanced CT scan of the abdomen revealed lobulated enhancing mass size 13cm × 11cm × 8cm arising from greater curvature of the stomach. There was heterogeneous enhancing nodule size 3cm at left adrenal gland. It measured 23.8 HU in non-contrast, 95.0 HU in enhanced and 56.5 HU in the delayed phase. The absolute enhancement washout was 53% and relative washout was 40%. The laboratory evaluation for the functional adrenal tumor was negative. Upper GI Endoscopy was normal.

OPERATION AND OUTCOME: The patient underwent laparoscopic subtotal gastrectomy with left adrenalectomy. The patient was placed in supine split leg position. The trocar positions are shown in the following picture. During laparoscopic exploration, a large extramural pedunculated mass was located in the gastric body. Subtotal gastrectomy was performed. Then Left adrenalectomy was performed by the transperitoneal approach. The tumor specimen was extracted through an extended umbilical incision. A Roux-en-Y gastrojejunostomy was constructed. ICG-enhanced fluorescence was used during left adrenalectomy and verified the adequate perfusion of the gastrojejunostomy anastomosis. There was no tumor rupture during surgery. The operation time was 270 mins. The postoperative course was uneventful and the patient was discharged postoperative day 5.
Pathological examination of extramural gastric mass was confirmed as GIST with a high level of mitotic activity. The left adrenal gland was atypical diffuse cortical hyperplasia.

CONCLUSION: Laparoscopic resection of a large gastric GIST is feasible in selected case. The minimally invasive treatment of coexisting abdominal pathologies such as gastric GIST and adrenal incidentalomas seem to be suitable and safe. The near-infrared (NIR) camera system in conjunction with ICG-enhanced fluorescence provides several benefits in terms of identifying vascular structures, enhance the borders of the tumor during adrenalectomy and help estimate the blood supply of visceral anastomosis, especially for an obese patient.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 94080

Program Number: V124

Presentation Session: Endocrine Videos

Presentation Type: Video

50

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2019 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Critical View of Safety (CVS) Challenge QR Code

The SAGES Critical View of Safety Challenge – Donate Your Lap Chole Videos!

The Society of American Gastrointestinal and Endoscopic Surgeons is hosting the first Artificial Intelligence Data Challenge conducted by surgeons. The aim of this challenge is to generate a large and diverse dataset of laparoscopic cholecystectomy videos, annotated with respect to the subcomponents of the Critical View of Safety (CVS). Computer scientists from all over the […]

Respuesta de SAGES al Estudio NordICC sobre el beneficio de las colonoscopias de detección

SAGES desea aclarar los resultados del estudio NordICC y colocarlos en contexto de los esfuerzos de varias agencias nacionales para reducir el riesgo de cáncer colorrectal – la segunda causa de muerte por cáncer más frecuente en los Estados Unidos-, mediante la promoción de la detección y tratamiento oportuno de las lesiones.

SAGES Response to NordICC Study Regarding Benefit of Screening Colonoscopies

The NordICC Study recently published in The New England Journal of Medicine and widely reported on by media outlets has raised questions regarding the benefit of screening colonoscopy in lowering the risk of colorectal cancer and cancer-related deaths among otherwise healthy and symptom-free men and women aged 55 to 64. Provocative headlines and commentaries have […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons