Robotic Assisted Single Incision Transgastric Resection of a 5 Centimeter Gastric Mass in Patient Status Post Coronary Artery Bypass Graft With Gastroepeploic Artery

Luca Giordano, MD FACS. Aria Health, Philadelphia,PA, USA

Laparoscopic transgastric excisions of gastric lesions, not amenable to endoscopic removal, have been reported. The pathology examination of those lesions usually dictate further treatment when necessary.
We report a case of a 78 years old male with past medical history significant for severe aortic stenosis, atrial fibrillation and coronary artery bypass graft done in the year 2009 with the use of the gastroepiploic artery. The patient was on anticoagulation therapy with coumadin. He presented to the emergency room with acute onset of upper gastrointestinal bleeding.
An Esophagogastrodoudenoscopy was performed revealing a 5 cm gastric mass with stigmata of bleeding, located on the lesser curvature. It was not possible to remove this lesion endoscopically. The patient gastroepiploic artery graft prevented the option of a formal gastrectomy at that time. The location of the lesion on the lesser curvature made it not amenable to a gastric wedge resection, and the need for patient anticoagulation pressed in proceeding to remove the etiology of the upper gastrointestinal bleed.
Robotic assisted single incision transgastric resection of the gastric mass seemed to be a valuable option, overcoming all the restrictions dictated by the case.
The procedure was uneventful. The patient had an uncomplicated post operative course, was advanced to a regular diet on post operative day number 2 and discharged to home on postoperative day number 7 with a therapeutic INR on coumadin.
The pathology exam showed a 5 x 4 x 3 cm inflammatory fibroid polyp. No further treatment was necessary.