Laparoscopic resection of the 3rd and 4th portion of duodenum for a gastrointestinal stromal tumor (GIST)
Epublication WebSurg.com, Oct 2007;07(10). URL: http://websurg.com/doi/vd01en2201
This video demonstrates the rather difficult procedure of laparoscopic resection of the distal duodenum. The duodenum is dissected from both above and below the transverse mesocolon. A hand-sewn duodenojejunal anastomosis restores bowel continuity. This video is recommended for upper GI surgeons. The patient is in the dorsal position with arms outstretched and legs abducted. The surgeon stands between the patient’s legs. Mobilization begins with adhesiolysis and then moves onto dissection of the duodenum with a Kocher's maneuver. The author completely mobilizes the third portion of duodenum. Once the surgeon identifies the third and fourth portions of the duodenum, ultrasound helps define the resection margins, initially marked with metallic clips. The procedure continues with division of the ligament of Treitz and resection of the first jejunal loop with a vascular stapler.