PMC3015503_01
Endoscopic localization of the tumor. Preoperative examination revealed a small, ulcerated, noncircumferential mass with no stigmata of recent bleeding in the gastric body. The lesion was located in the body on the anterior wall (arrow); asterisk denotes lesser curvature.
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F1
Despite the treatment initiated, the patient continued having symptoms and underwent a repeated endoscopy that showed a 13x3-mm mass near the lesser curvature anteriorly in the body of the stomach and a biopsy consistent with carcinoid tumor (Figure 1).
Intraoperative tumor localization. The tumor was endoscopically tattooed with India ink allowing posterior localization during surgery. Arrows denote the abnormality area limited to the body of the stomach.
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F2
Due to the relatively small size and flat aspect of the lesion, an endoscopic India ink tattooing technique was performed to facilitate subsequent laparoscopic localization (Figure 2).
The area was grasped and wedge resection of the tumor was achieved by firing staples with an endo GIA stapler using 30-3.5 loads. A small amount of oozing from the staple line was stopped with clips.
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F3
The area of abnormality was grasped and brought up and an endo GIA stapler with a 30-3.5 load was used to sequentially pass underneath the area, leaving a careful margin around the abnormality (Figure 3).
Prior to the last firing, the feeding vessels from the lesser curvature were taken down with a Harmonic scalpel.
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F4
Prior to the firing of the last staple, the feeding vessels from the lesser curvature were taken down using the Harmonic scalpel (Figure 4).