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New access to intraluminal gastric pathologies: the SP da Vinci transgastric approach
Franziska Renger1, Alessandro Francesco Armienti2, Yulia Brecht1
1Department of General-, Visceral-, and Transplantation Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
Background:
Surgical management of gastric submucosal tumors in anatomically challenging sites such as the gastroesophageal junction (GEJ), fundus, or proximal lesser curvature remains technically demanding. The da Vinci single-port (SP) robotic platform may provide a minimally invasive, organ-preserving alternative by enabling stable endoluminal access and precise dissection.
Methods:
We conducted a case series of five patients who underwent SP robot-assisted transgastric resections for circumscribed gastric pathologies between May and August 2025. Patient demographics, tumor characteristics, operative details, pathology, and short-term outcomes were analyzed.
Results:
Two patients presented with gastric metastases from malignant melanoma, one with a neuroendocrine tumor (NET), one with a gastrointestinal stromal tumor (GIST), and one with a leiomyoma. All lesions were located in anatomically challenging areas and ranged in size from < 1 cm to 5.5 cm. Four patients underwent submucosal dissection, and one required full-thickness resection. Operative times ranged from 66 to 134 min. Median console time was 38 min. No bleeding, conversion, tumor rupture, or spillage occurred. Patients were discharged between postoperative day (POD)-3 and POD-7, with no reoperations, morbidity, or 30-day mortality. Histopathology confirmed R0 resection of one GIST and both melanoma metastases; the NET G2 had positive margins but very low proliferative activity (Ki-67 < 0.1%).
Conclusions:
Da Vinci SP robot-assisted transgastric resection is a feasible and safe organ-preserving technique for GEJ and gastric tumors. The platform offers great exposure, stable endoluminal access, and three arms for dissection. This technique complements established endoscopic and laparoscopic procedures. The presented method could also be combined with extraluminal lymphadenectomy. Larger studies with long-term follow-up will define optimal indications and the role of this innovative approach within minimally invasive gastric surgery.