Valentina Valle, MD, Alberto Mangano, MD, Roberto Bustos, MD, Gabriela Aguiluz, MD, Pier Cristoforo Giulianotti, MD, FACS. University of Illinois at Chicago
Introduction: 52 years old man, cigarette smoker, complaining of intermittent abdominal pain and 5 lb weight loss. EGD: non bleeding gastric ulcer. Pathology report on biopsies: gastric adenocarcinoma with H Pylori Gastritis. Past Medical and Surgical History: negative.
Methods and Procedures: Robotic Total Gastrectomy with en-block distal Splenopancreasectomy, left Adrenalectomy, D2 Lymphadenectomy and Omentectomy. After the isolation of the esophagogastric junction and the exploration of the Lesser sac, the gastric fundus is exposed and it appears to be fused to the pancreatic tail. Hence, an en-block resection is performed. The right gastroepiploic vessels and the right gastric artery are divided. Linfoadenectomy along the hepatic artery and the celiac trunk.The left gastric artery is divided by a vascular stapler. After the transection of the splenic artery, the pancreas is separated from Gerota capsule and the pancreatic tail and splenic vein are divided. An adrenalectomy is performed to maintain an oncologically radical resection. The left adrenal vein is divided between suture of 4-0 Prolene and the adrenal gland is separated from the kidney upper pole. The specimen is completely removed en block and it includes the stomach, the omentum, the pancreatic tail, the spleen and the left adrenal gland. Undocking. Specimen extraction by a small midline incision and a Roux-en-Y anastomosis with stapler and PDS 3-0 is performed. Redocking. Manual end-to-side esophagojejunostomy with double layer 3-0 Prolene was completed and tested.
Results: Operative Time: 263 min. Blood loss: 100 cc. Discharge in the 7th POD. Uneventful post-operatory course. Permanent pathology: Infiltrating Poorly differentiated Grade 3 Gastric Adenocarcinoma (4.3 x 3.4 x 0.4cm), invading the splenic capsule and the peri pancreatic adipose tissue, with metastasis to the adrenal gland. (pT4b, pN1, pM1). Resection margins tumor free.
Conclusion: Complex multiorgan resections are technically feasible and safe if performed in high volume and high expertise centers. The reduced blood loss (no transfusion needed in this case), the short hospitalization with a good quality of life allow a short time between surgery and the beginning of the oncological treatment. The robotic platform offers several advantages, including 3D vision, superior instruments dexterity and better ergonomy. Robotic technology may became surgeon’s preferred treatment modality and potentially it may extend the boundaries of the minimally invasive approach to increasingly more challenging scenarios.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94236
Program Number: V181
Presentation Session: Video Loop Day 1
Presentation Type: VideoLoop