The accompanying video demonstrates a robotic subtotal gastrectomy, lymphadenectomy, and intracorporeal gastrojejunostomy and jejunojejunostomy.
The patient was a 54-year-old woman who presented with abdominal pain and nausea. Esophagogastroduodenoscopy (EGD) identified a 1-cm nodule which was biopsied and demonstrated neuroendocrine tumor. The lesion was on the lesser curve 6 cm distal to the gastroesophageal junction. Endoscopic ultrasound demonstrated a 1-cm perigastric lymph node, which was biopsied and positive for neuroendocrine metastasis. Gallium-68 DOTATE PET was performed and showed no other metastatic disease. Subtotal gastrectomy with lymphadenectomy was recommended for this type 3 gastric carcinoid.
The technical steps of the oncologic resection and reconstruction are shown in the video.
Pathology demonstrated a 9-mm well differentiated neuroendocrine tumor with negative margins, one of 21 lymph nodes were positive.
In conclusion, minimally invasive subtotal gastrectomy can be performed using the robotic platform. We find that the improved stability and dexterity afforded by this technology is particularly beneficial for the lymphadenectomy and reconstruction.