Single Incision Laparoscopic Resection of a Gastric Gastrointestinal Stromal Tumor

A 46 year-old man presented with acute onset hematemesis and a 10-pound unintended weight loss over a two-month period. Upper gastrointestinal endoscopy demonstrated a 3-cm ulcerated, hemorrhagic submucosal mass in the cardia of the stomach, suspicious for a gastrointestinal stromal tumor (GIST). A CT scan corroborated these findings. The patient was referred for surgical evaluation, whereupon partial gastric resection was recommended. Partial gastrectomy was performed using a single incision (SILS™ port, Covidien, Mansfield, MA) laparoscopic technique. The patient made uneventful recovery, was discharged on the second postoperative day, and remains well six months postoperatively. Histopathology and immunohistochemistry revealed a mass with submucosal and serosal components together measuring 8-cm in greatest dimension, and a final diagnosis of GIST (spindle cell type) with c-kit/CD 117, CD 34 and cytokeratin positivity. GISTs arise from the interstitial cell of Cajal, a pacemaker cell of the gastrointestinal tract. They are often asymptomatic, but can present with acute hematemesis or melena when ulcerated, as in this case. Resection with a negative margin without lymphadenectomy is the treatment for most GISTs, making them amenable to minimally invasive techniques. This video presentation demonstrates SILS™ partial gastrectomy as a viable minimally invasive approach to the management of GIST for surgeons familiar with single incision and single port techniques.

Session: Video Channel

Program Number: V083

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