Laparoscopic partial sleeve-like gastrectomy for benign schwannoma

Schwannomas, also known as neurinomas, are generally benign, slow-growing neoplasms representing 0.2% of all gastric tumors. This is the case of a 48-year-old patient presenting with epigastralgias. A 4cm lesion is found as evidenced by the CT-scan. Gastroscopy and endoscopic ultrasonography did not show any mucosal lesion. This video shows a laparoscopic sleeve-like gastrectomy of this benign tumor.

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Laparoscopic partial sleeve-like gastrectomy for benign schwannoma

Authors

F Costantino, B Dallemagne, J Marescaux

Abstract

Schwannomas, also known as neurinomas, are generally benign, slow-growing neoplasms representing 0.2% of all gastric tumors. This is the case of a 48-year-old patient presenting with epigastralgias. A 4cm lesion is found as evidenced by the CT-scan. Gastroscopy and endoscopic ultrasonography did not show any mucosal lesion. This video shows a laparoscopic sleeve-like gastrectomy of this benign tumor.

Classification

tips and tricks

Keywords

Laparoscopic partial sleeve-like gastrectomy, benign schwannoma

Media type

Surgical video

Duration

05'14''

Publication

2009-10

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E-publication

WeBSurg.com, Oct 2009;9(10).
URL: http://www.websurg.com/doi-vd01en2740.htm

Laparoscopic partial sleeve-like gastrectomy for benign schwannoma

1. Introduction 00'08''

This video shows the laparoscopic resection for a benign tumor located on the anterior aspect of the gastric body. This tumor was discovered incidentally as demonstrated here by the contrast swallow and follow-through examination.

2. Clinical case 00'29''

This is the case of a 48-year-old patient presenting with epigastralgias. A 4cm lesion is found as evidenced by the CT-scan. Gastroscopy and endoscopic ultrasonography did not show any mucosal lesion. A laparoscopic approach is decided upon. Lymph node sampling is carried out at the right gastro-omental artery.

3. Trocar positioning 01'10''

The procedure starts with a 10mm, 30 degree scope positioned at epigastric level. Two 5mm ports are placed in the right and left flank and a third 5mm port placed in the epigastrium is used to retract the liver. The lymph node sampling is performed using the 5mm Ligasure device making sure to preserve the right gastro-omental artery. The vascular supply of the greater curvature of the stomach is also preserved. This node sampling is sent to the frozen section. The findings indicate the benign character of the lymph node. Considering the presence of a second lymph node at the level of the left gastric artery, we perform a second sampling at the lesser omentum using the 5mm Ligasure device. A vascular control of the lymph node vascularization is achieved using the 5mm Ligasure device. Progress is uneasy and as can be observed here, the complete resection of this lymph node is carried out. Once resected, the lymph node is sent to the frozen section lab. Findings rule out the presence of neoplasia. At this moment, we decide to perform an atypical gastrectomy.

4. Greater curvature dissection 03'14''

We start by freeing the branches supplying the greater curvature of the stomach beginning from the left gastro-omental artery and moving distally towards the branches of the right gastro-omental artery. We find each other 3cm distal and proximal margins to the tumor.

5. Atypical gastrectomy 03'40''

Since the intraoperative endoscopy did not show any mucosal lesion, we decide to perform the gastrectomy using an Endo-GIA linear stapler, blue cartridge. A 60 French calibration tube had been placed previously to preserve a correct gastric diameter.

6. Specimen extraction 04'15''

Once the gastric resection has been completed in an atypical fashion, the specimen is placed into a plastic bag for extraction.

7. Staple line running suture 04'31''

A running suture is placed to strengthen the staple line using monofilament absorbable 3/0 material. This is achieved in order to prevent the risk of fistula that may originate from the staple line. Control of the hemostasis is carried out. This marks the end of the procedure. The specimen is sent for pathological examination, which demonstrated the presence of a benign schwannoma at the anterior portion of the gastric fundus.