Robotic excision of gastric and duodenal gastrointestinal stromal tumor

Gastrointestinal stromal tumors (GIST) originate from interstitial cells of Cajal and are most often located in the stomach. The mainstay of treatment for GIST is surgical resection. Laparoscopic wedge resection of gastric GIST using linear staplers has been commonly performed and shown to be feasible and safe. However, this technique is not suitable for tumors at particular anatomical locations such as the gastric cardia near the gastroesophageal junction, the lesser curvature of stomach, and the duodenum. The robotic surgery platform with augmented surgical skills has enabled precise dissection and suturing. We consider robotic GIST excision with primary suture closure to be useful for lesions in the above-mentioned locations. In this video, we demonstrate our techniques of robotic excision of gastric and duodenal GIST. At our institution, 13 patients underwent robotic excision of gastric and duodenal GIST between November 2018 and July 2021. Tumor locations included the cardia (n = 2), gastric body (n = 10) [lesser curvature (n = 3) and other (n = 7)], and the duodenum (n = 1). There were no conversions to open laparotomy. The median operation time was 160 min (range 80-270), and median blood loss was 25 mL (range 5-50). The median length of hospital stay was 3 days (range 1-4). There were no complications or readmissions within 90 days. We demonstrated the feasibility and safety of robotic resection of GIST located at the stomach and duodenum. Especially in anatomically challenging locations where the stapling technique is not suitable, robotic approaches are considered useful for performing precise excision.