Gastrointestinal stromal tumours of stomach: Robot-assisted excision with the da Vinci Surgical System regardless of size and location site
Niccolo Furbetta1, Matteo Palmeri1, Simone Guadagni1, Gregorio Di Franco1, Desirée Gianardi1, Saverio Latteri2, Emanuele Marciano1, Andrea Moglia3, Alfred Cuschieri4, Giulio Di Candio1, Franco Mosca3, Luca Morelli5
1 General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa, Italy
2 General Surgery Unit, Cannizzaro Hospital, Catania, Italy
3 EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
4 Sant'Anna School of Advanced Study, Pisa, Italy
5 General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa; EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
Department of Surgery, General Surgery Unit, University of Pisa, Italy, Via Paradisa 2, Pisa 56125
Source of Support: None, Conflict of Interest: None
Aims: The role of minimally invasive surgery of gastrointestinal stromal tumours (GISTs) of the stomach remains uncertain especially for large and/or difficult located tumours. We are hereby presenting a single-centre series of robot-assisted resections using the da Vinci Surgical System (Si or Xi).
Subjects and Methods: Data of patients undergoing robot-assisted treatment of gastric GIST were retrieved from the prospectively collected institutional database and a retrospective analysis was performed. Patients were stratified according to size and location of the tumour. Difficult cases (DCs) were considered for size if tumour was >50 mm and/or for location if the tumour was Type II, III or IV sec. Privette/Al-Thani classification.
Results: Between May 2010 and February 2017, 12 consecutive patients underwent robot-assisted treatment of GIST at our institution. DCs were 10/12 cases (83.3%), of which 6/10 (50%) for location, 2/10 (25%) for size and 2/10 (25%) for both. The da Vinci Si was used in 8 patients, of which 6 (75%) were DC, and the da Vinci Xi in 4, all of which (100%) were DC. In all patients, excision was by wedge resection. All lesions had microscopically negative resection margins. There was no conversion to open surgery, no tumour ruptures or spillage and no intraoperative complications.
Conclusion: Our experience suggests a positive role of the robot da Vinci in getting gastric GIST removal with a conservative approach, regardless of size and location site. Comparative studies with a greater number of patients are necessary for a more robust assessment.