Single incision transumbilical laparo-endoscopic gastric benign tumor resection

This video shows a single incision transumbilical laparo-endoscopic gastric benign tumor resection using double curved instruments. The double-curved instrument is interesting because it allows for correct triangulation of the tools but also for retraction of the left lobe of the liver during dissection.

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Single incision transumbilical laparo-endoscopic gastric benign tumor resection

Authors

G Dapri, J Himpens, GB Cadière

Abstract

This video shows a single incision transumbilical laparo-endoscopic gastric benign tumor resection using double curved instruments. The double-curved instrument is interesting because it allows for correct triangulation of the tools but also for retraction of the left lobe of the liver during dissection.

Classification

single port, contribution

Keywords

Single incision, transumbilical, laparo-endoscopic, gastric benign tumor, resection

Media type

Surgical video

Duration

05'06''

Publication

2011-01

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E-publication

WeBSurg.com, Jan 2011;11(01).
URL: http://www.websurg.com/doi-vd01en3122.htm

Single incision transumbilical laparo-endoscopic gastric benign tumor resection

1. Introduction 00'19''

This 26-year-old patient presents a benign lesion of the cardia that will be resected by single incision laparoscopy. A purse-string is performed in the umbilicus. A reusable 10mm trocar is inserted for the optical system. We will use a double-curved grasping forceps that is introduced outside the purse-string through a window in the aponeurosis. The double-curved instrument is interesting because it allows for correct triangulation of the tools but also for retraction of the left lobe of the liver during dissection.

2. Peroperative gastroscopy 01'09''

Gastroscopy is performed and in retrovision the lesion is localized and by external pressure with the curved forceps by laparoscopy, the location of the lesion is ascertained. A double-curved needle holder is inserted and a suspension suture is placed at the apex of the lesion. Reusable material is used and the suspension suture will obviously help for counter-traction.

3. Lesion dissection by gastroscopic control 02'03''

The ultrasonic scissors are used for the resection itself. Now the problem with this surgery is obviously the security margin, which can be ascertained either by ultrasound or like here, by gastroscopic control.

4. Completion of lesion resection 02'32''

A grasper is introduced through the working channel of the gastroscope and is held at safe distance from the lesion in order to direct the resection, especially on the far side of the stomach. Eventually a good chunk of tissue is taken out. A custom-made plastic bag is introduced through the trocar and the specimen is placed inside the bag, which is now retrieved with the grasper inside the purse-string. The scope and the trocar are taken out together with the bag.

5. Defect closure 03'25''

The defect is closed by two converting running sutures of 2/0 absorbable suture material introduced through the 10mm trocar. The suture presents a preformed knot at the tail, which will save the tying of one knot. One can observe the perfect triangulation of the tools at all times despite the fact that we are working through a single incision. This is obviously thanks to the double curvature of the tools. A regular suturing technique is used and at the end of the sewing maneuver, the knot will be tied with an intracorporeal knotting technique. Ergonomic conditions are acceptable as can be seen from this outside picture. Obviously, this triangulation helps in the performing of the knot. In order to check the quality of the suture, an air leak test is performed under immersion and the gastroscopic check is performed as well. The purse-string that had been introduced in the beginning is tied and the size of the incision is confirmed to be 1.5cm.