Robotic and Laparoscopic Wedge Resection in Gastric GIST

Paolo Pietro Bianchi (Grosseto – Italy) Wanda Petz (Milano – Italy) L. Casali, M. Parodi, D. Belotti

Robotic approach can allow a minimally invasive approach even to gastric GIST located near the oesophago-gastric junction or the pylorus. The video presents 3 cases of robotic wedge resections. The patients were 42, 44 and 78 years old with a gastric GIST located at the antrum, immediately proximal to the pylorus in one case, and on the posterior gastric wall near the oesophago-gastric junction in the remaining two cases. Diagnosis was performed with CT scan, endoscopic ultrasound and confirmed by biopsy. With patients in dorsal decubitus and open legs, one optical supraumbilical trocar, three 8 mm robotic trocars in left and right hypocondrium and two accessory trocars in the left flank were inserted. Intraoperative ultrasonography confirmed the exact localization of the lesion. In the proximally-located GIST, mobilization of the greater curvature was realized with sectioning of short vessels; a gastrotomy was then performed and the tumour resected by harmonic scalpel. The gastrotomy was closed by two-layer absorbable running sutures. Operative time was 180 minutes, blood loss was negligible, no intraoperative and postoperative complications occurred. Oral feeding was started on third postoperative day after a negative radiographic contrast study, and patients were discharged on fourth postoperative day. Histopathological examination confirmed the diagnosis of GIST and the negative margins of the surgical specimens. Robotic assistance allows precise dissection of tumors located in the paracardial and prepyloric region, and facilitate fine surgical gesture as gastric wall suture.