Ultrasound-Guided, Robotic Gastrointestinal Stromal Tumor Resection

Gregory Tiesi, MD, Sebastian Eid, MD, Donald McCain, MD, FACS

Department of Surgery, Hackensack University Medical Center, Hackensack, NJ, USA (Drs. Tiesi, Eid). Department of Surgical Oncology, Hackensack University Medical Center, Hackensack, NJ, USA (Dr. McCain).

ABSTRACT

Introduction: Despite evolving experience with laparoscopic resections of gastric gastrointestinal stromal tumors (GISTs), there are few data describing robotic resections. Here we describe the robotic removal of a gastric GIST using laparoscopic ultrasonography for tumor localization.

Case Description: The patient is a 46-year-old African-American man with a biopsy-proven 3.5 X 3.5-cm GIST along the greater curvature of the stomach, and with no evidence of metastatic disease on preoperative computed tomographic staging. Three robotic ports (12-mm umbilical, 8-mm left lower quadrant, and 8-mm subxiphoid) were combined with a 12-mm right lower quadrant assist port and a right midabdomen 8-mm port for the laparoscopic liver retractor. Mass localization was facilitated by intraoperative ultrasonography and dissection performed with bipolar electrocautery via dissecting forceps. Resection was performed using a stapled technique and the specimen removed via the assist port. Total operative time was 104 minutes and estimated blood loss was 25 mL. There was no significant morbidity. Length of stay was 3 days, and the patient returned to work within 1 week. The retrieved specimen was CD117- and DOG1-positive with 2 to 3 mitoses/hpf. At 1-year follow-up, there was no evidence of disease.

Discussion: This case report describes a novel and efficient technique for the robotic removal of a gastric GIST. This resection can be safely performed with the aid of intraoperative ultrasonography instead of gastroscopy or gastrotomy for identification of resection margins.

Key Words: Gastrointestinal stromal tumor, Robotics, Laparoscopic ultrasonography.

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