Minimally invasive treatment of gastric gastrointestinal stromal tumors: Laparoscopic gastric wedge resection and Robotic distal gastrectomy

A. Parisi

The stomach is the most common site for the development of gastrointestinal stromal tumours. The minimally invasive procedure is debated and must be evaluated based on the risk of breakage and fragmentation of the neoplasm. The surgical treatment consists in resectioning the entire neoplastic mass and a section of the gastric wall enough to bring down the resection margins on the healthy tissue. The type of technique used depends on the location and size of the tumour. GISTs that are localised along the large gastric curve can be treated easily with limited resections such as a wedge resection. On the contrary, for damage occurring at the antral or pre-pyloric level, it is risky to remove only the tumour because it could generate a cicatricial stenosis of the gastric lumen that in this portion has reduced dimensions. In this case, the best strategy is to implement distal gastrectomy. The role of mini-invasive surgery in treating GIST is not debated because of the difficulties in performing the procedure, but because of the fragility of the lesion to be treated, and, therefore, the need to avoid intraoperative breakage and the intraperitoneal dissemination of the tumour. Robotic surgery begins to play an important role in digestive surgery and several studies on the use of robots for gastric diseases have underlined the effectiveness and feasibility of this minimally invasive approach. In this video content, we report a laparoscopic approach for a GIST of the greater curvature of the stomach and the use of the Da Vinci robotic surgical system to perform a distal gastrectomy in a case of pyloric GIST. In particular, we intend to highlight the utility of the robot in performing the reconstructive phase after gastric resection.