Partial antrectomy for gastric tumor

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Partial   antrectomy   for   gastric   tumor

Authors
J Leroy, D Mutter, M Smith-Savu
Mots-clés
gastrectomy,operation,stomach
Type de vidéo
Durée
06'00''
Publication
2004-09
Popularité
Favoris
Favorites Media
Audio
en
Sous-titres
en
E-publication
WeBSurg.com, Sept 2004;4(09).
URL: http://www.websurg.com/doi-vd01en1139e.htm

Partial   antrectomy   for   gastric   tumor

1. Case presentation 00'16''
In this film, we’re going to show the removal of an extraluminal benign tumor located at the anterior aspect of the antrum of the stomach. Once we have entered the abdominal cavity, we can see that the tumor is easily located. We will begin with 4 ports: one port will be placed at the umbilicus and 2 ports will be placed lateral to the umbilicus at the mid-clavicular line and the 4th port will be placed in a suprapubic position. Once we have easily located this tumor on the anterior aspect of the antrum, we can see that we can place a grasper behind the tumor. The pedicle of the tumor is readily mobilized and we feel that we can easily place a stapler at this position. The purpose here is to widely resect at a distance from the pedicle using the linear stapler with a green cartridge. This stapler has 2mm high staples, which will be adequate for the thickness of the antrum at this location. The 1st stapler is placed by elevating the tumor and placing it at a distance again from the pedicle to include the vascular supply. Once it is well positioned, it is closed and the resection is performed. To completely widely resect the base of the pedicle, we will use 2 cartridges in this instance. Here we must resect widely at the base of the tumor but also we continue to keep the lumen of the antrum of the stomach. This is easily achieved due to this spacious lumen of the stomach. We can see here we can complete our dissection using scissors. Once we have completely mobilized the tumor from the antrum of the stomach, we will now address the adherences of the omentum to the tumor. In order to take down the adhesions from the tumor, we can either use the Harmonic scissors or the stapler using the white cartridge as we choose to do here. The vascular cartridge for the staple uses 1mm staplers to control any bleeding. We do this dissection from medial to lateral until it’s completely free from the omentum and we have completely liberated the tumor. We try not to manipulate the tumor due to the risk of contamination and the possibility that postoperative pathology may show cancer cells. Throughout the whole procedure, we must keep in mind that we must respect the lumen of the stomach but also make a wide resection around the tumor itself until we know the final pathology. As you can see here, we have completely liberated the tumor along with the portion of the antrum of the stomach and the adherences of the omentum. Now that we have completely mobilized the tumor, we will introduce an Endo-catch bag through the suprapubic port to place the tumor into this bag. We can see that it is a large size bag, which completely encases the tumor. We close the bag. We remove the bag applicator. And for the moment, we leave the specimen inside while we check hemostasis. We carefully are looking at all our staple lines to make sure that there is no bleeding or residual oozing from the sites. We do have some bleeding that can be corrected with bipolar using suture or simple coagulation. Once we are sure that there is no bleeding, we enlarge the suprapubic port and we will introduce a plastic drape protector through this port over the trocar. This will further protect the trocar site as we move the specimen, which is now completely removed from the abdominal cavity.