TECHNIQUE
The patient was transferred to the operating room and placed on the
operating table in the supine position. The patient was sedated and
intubated without any complications. Her abdomen was then prepped and
draped in a sterile fashion. We did start with the placement of a 5 mm port
just above the umbilicus using the Optiview technique under direct
visualization. The port was placed without any complications. A
pneumoperitoneum was obtained. We then visualized the stomach and were
trying to evaluate for the area that was tattooed by the
gastroenterologist. We did note that there was what appeared to be color
change along the greater curve of the antrum, however, this looked to be on
the underside of the stomach. To better evaluate this, we went ahead and
performed an EGD intraoperatively to confirm where the site of the tattoo
was, as well as the lesion. This area was transilluminated and was easily
visualized laparoscopically. We then placed an additional 5 mm trocar in
the right upper quadrant and 2 further trocars, 1 immediately above the
umbilicus and 1 in the left upper quadrant. We were able to mobilize the
gastrocolic ligament with the Harmonic scalpel, exposing the posterior
aspect of the stomach along the antrum. Using guidance with the EGD, we
were able to grasp the lesion with a Prestige grasper and noted the entire
lesion within our grasper through the EGD. At this point in time, we were
able to upsize our left upper quadrant port to a 12 mm trocar and, using a
60 flex HD Ethicon stapler with green loads and Peri-Strips, we were able
to wedge out the lesion with 4 fires of the stapler. We ensured that there
was no stricturing of the pylorus. We then rescoped her stomach with no
findings of any complications. There was bluish demarcation of the mucosa
where the line of our staplers were.
We sent the specimen immediately to pathology. They opened the specimen
immediately and noted that there was an area of tattoo, however, did not
immediately see the lesion. On inspection by Dr. Derrick, he felt that the
lesion was within the specimen, as well as potentially the staple line. No
lesion was noted on EGD.
The decision was made at this time to complete the procedure. Hemostasis
was obtained. Port sites were injected with 0.5% Marcaine. We suctioned out
the stomach with the EGD scope, desufflated the abdomen, and closed the
fascial defect and 12 mm port with 0 PDS stitch. The skin incisions were
reapproximated with 4-0 Monocryl stitches, cleansed and dressed with
Dermabond. The patient tolerated the procedure well. She was extubated and
returned to the recovery room in stable condition.
