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Robotic Vagus-Sparing Total Gastrectomy for CDH1 Gene Mutation Treatment.

Daniel L Chan¹, Michael L Talbot²

¹Saint George and Sutherland Clinical School, Faculty of Medicine, The University of New South Wales; daniel.l.chan@unsw.edu.au.

Journal of Visualized Experiments : Jove

|December 25, 2023

Summary

Robotic minimally invasive surgery offers a new approach for prophylactic total gastrectomy in patients with Hereditary Diffuse Gastric Cancer (HDGC) due to CDH1 gene mutations, preserving vagus nerve function.

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Area of Science:

Surgical Oncology
Gastroenterology
Robotic Surgery

Background:

Hereditary Diffuse Gastric Cancer (HDGC) is linked to CDH1 gene mutations, significantly increasing gastric cancer risk.
Screening gastroscopy is often ineffective for early HDGC detection.
Prophylactic total gastrectomy is the recommended preventative treatment for individuals with HDGC.

Observation:

A 24-year-old male with a confirmed CDH1 gene mutation and family history of HDGC underwent a prophylactic total gastrectomy.
The procedure utilized robotic minimally invasive surgery (MIS) techniques.
Key steps included patient positioning, port placement, posterior vagus-preserving dissection, and Roux-en-Y reconstruction.

Findings:

Robotic surgery facilitated MIS for total gastrectomy, including complex anastomoses and posterior vagus preservation.
The case report details specific techniques and potential challenges in robotic foregut surgery.
The demonstrated techniques can be adapted for various foregut and general surgery procedures.

Implications:

Robotic surgery enhances the feasibility of minimally invasive techniques for prophylactic gastrectomy in HDGC patients.
Vagus-preserving robotic surgery may reduce adverse functional outcomes in patients undergoing total gastrectomy.
These robotic surgical techniques have broader applicability in foregut and bariatric surgery.