Laparoscopic Gastric Wedge Resection for a GIST Vahagn G. Hambardzumyan, MD1; Martin Goodman, MD2 1Yerevan State Medical University, Heratsi Hospital Complex 2Tufts University School of Medicine
The stomach is involved in multiple common ailments, including gastroesophageal reflux disease, gastric ulcers, and cancer, the latter of which can take many forms. Originally, GISTs arise from the connective tissue, or stroma, of the stomach, rather than the lining, from which the more common and more deadly gastric adenocarcinoma finds its origin. However, over time, study revealed that GIST arises from a very specific cell, called the interstitial cells of Cajal, that are responsible for the timing of contraction in the stomach and small intestine. GIST masses generally behave more indolently than gastric adenocarcinoma, with distant or lymph node metastases a rare feature, although involvement of the liver and peritoneum has been described. Due to this indolent nature, certain masses, once they have been identified as GIST through endoscopic biopsy, are candidates for surveillance. However, larger masses (as identified through evidence of necrosis on imaging) and rapidly growing masses are treated primarily with surgical resection. While in the past surgical resection would have involved a large abdominal incision and a lengthy postoperative recovery, laparoscopic techniques have allowed gastric resection to become a short procedure necessitating only an overnight stay.
The gold standard for achalasia is surgical correction via laparoscopic Heller myotomy with a partial fundoplication. The goal of this technical report is to illustrate the authors preferred approach to patients with achalasia and to provide the reader with a detailed description of his operative technique, its rationale, and preoperative and postoperative management.
This case illustrates a laparoscopic resection of a gastrointestinal stromal tumor (GIST): the most common mesenchymal tumor found in the gastrointestinal tract. GISTs can be found anywhere along the gastrointestinal tract; however, they are most commonly found in the stomach and small intestine. These tumors are often associated with mutations in the KIT (receptor tyrosine kinase) and PDGFRA (platelet-derived growth factor receptor alpha) genes. Because it is difficult to achieve a permanent cure using protein tyrosine kinase inhibitors, such as imatinib, surgical resection is the recommended therapy in most cases. While the surgical approach may vary on tumor characteristics, the laparoscopic approach is associated with low perioperative morbidity and mortality.
The origins of laparoscopic surgery trace back to the introduction of diagnostic laparoscopy in the 1960s. Subsequently, the approach underwent a notable evolution, transitioning from a primarily diagnostic procedure to a surgical technique. Laparoscopy, a type of minimally invasive surgery, was introduced to address issues related to significant tissue trauma, large cosmetic scars, and prolonged hospitalizations. This video provides a step-by-step demonstration of the assembly, disassembly, use, and handling of laparoscopic tools on the example of a basic Karl Storz laparoscopy kit.
In patients with difficult gallbladders due to anatomy prohibiting a clear critical view of safety, a subtotal cholecystectomy can be considered as a safer alternative to a total cholecystectomy. Subtotal cholecystectomies can be divided into “reconstituting” or “fenestrating.” Subtotal reconstituting cholecystectomies include closing off the lower end of the gallbladder to create a remnant gallbladder, while subtotal fenestrating cholecystectomies do not occlude the gallbladder and instead may involve suturing the cystic duct. The most common indication for subtotal fenestrating cholecystectomy is inflammation in the hepatocystic triangle, and subtotal fenestrating cholecystectomy has proven to be useful specifically for patients with a history of cirrhosis.
This case report describes the performance of a subtotal fenestrating cholecystectomy for the management of acute on chronic cholecystitis in a patient with cirrhosis initially managed with transcystic stent placement endoscopically. Management of this patient’s omental adhesions to the gallbladder required alterations to typical surgical technique, which will be described in this report. Additionally, the indications for subtotal fenestrating cholecystectomy will be discussed alongside the benefit of this technique to specific patient populations presenting with acute on chronic cholecystitis.
Over the past decade, laparoscopic donor nephrectomy has gradually replaced the conventional open approach and has become the standard of care in living donor kidney transplantations. Compared to open nephrectomy, laparoscopic nephrectomy reduces postoperative pain, shortens the length of hospital stay, and improves the cosmetic outcome. This article illustrates the author’s technique of pure laparoscopic donor nephrectomy.
Colonic polyps are projections from the surface of the colonic mucosa. Most are asymptomatic and benign. Over time, some colonic polyps develop into cancers.
Carcinoid tumors develop from cells in the submucosa. They are slow-growing neoplasms. Carcinoid tumors of the colon are rare, comprising less than 11% of all carcinoid tumors and only 1% of colonic neoplasms. The majority of patients diagnosed with carcinoid tumors have no symptoms, and their tumors are found incidentally during endoscopy.
This is the case of a middle-aged male who had an unresectable polyp in the ascending colon and a carcinoid tumor in the ileocecal valve. The patient underwent laparoscopic right colectomy with ileocolic anastomosis to remove both lesions.
This is the case of a 66-year-old man with a history of colon polyps, who undergoes colonoscopy every 3 years for surveillance. During the last colonoscopy, he was found to have a polyp at the appendiceal orifice. The biopsy showed the presence of adenoma.
Therefore, the patient underwent a laparoscopic appendectomy with wedge resection of the cecum. The operation went well and took less than an hour. The specimen was opened, and the adenoma was found within the lumen of the appendix, with at least 1.5 cm of clear margin. The patient was sent home the same day, and resumed regular diet and physical activities the following morning.
Acute appendicitis is a medical condition where the appendix becomes inflamed and causes pain in the lower right quadrant of the abdomen. In addition to pain, appendicitis can cause peritonitis, perforations, and can lead to death if left untreated. Laparoscopic appendectomy is the standard surgical procedure to treat the symptoms of appendicitis as well as prevent further spread of infection. While appendicitis typically advances in an irreversible fashion necessitating surgery, conservative management with antibiotic therapy can sometimes resolve symptoms.
In this case, a 24-year-old patient had a delayed presentation with acute perforated appendicitis. Following successful non-operative treatment with antibiotics, she presented for a laparoscopic interval appendectomy. She also had a non-symptomatic umbilical hernia, which was repaired following removal of the laparoscopic ports for the appendectomy.
This is the case of an 87-year-old female who presented with a history of constipation and bothersome rectal prolapse that required manual rectal prolapse reduction. She had minimal constipation and minimal incontinence, and anorectal manometry revealed low rectal pressures. On exam, she was found to have full-thickness rectal prolapse and stage II posterior vaginal wall pelvic organ prolapse. Gynecological POP-Q exam showed mostly posterior prolapse and some apical prolapse, and urodynamic testing was negative. Defacography revealed an enterocele. Here, Dr. Bordeianou and Dr. Von Bargen at MGH discuss the decision-making process when treating rectal prolapse and perform a laparoscopic suture rectopexy with culdoplasty, vaginal wall repair, and perineorrhaphy with levator plication.
