Furbetta Niccolò, Palmeri Matteo, Guadagni Simone, Di Franco Gregorio, Gianardi Desirée, Latteri Saverio, Marciano Emanuele, Moglia Andrea, Cuschieri Alfred, Di Candio Giulio, Mosca Franco, Morelli Luca
General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa, Italy.
General Surgery Unit, Cannizzaro Hospital, Catania, Italy.
J Minim Access Surg. 2019 Apr-Jun;15(2):142-147. doi: 10.4103/jmas.JMAS_260_17.
The role of minimally invasive surgery of gastrointestinal stromal tumours (GISTs) of the stomach remains uncertain especially for large and/or difficult located tumours. We are hereby presenting a single-centre series of robot-assisted resections using the da Vinci Surgical System (Si or Xi).
Data of patients undergoing robot-assisted treatment of gastric GIST were retrieved from the prospectively collected institutional database and a retrospective analysis was performed. Patients were stratified according to size and location of the tumour. Difficult cases (DCs) were considered for size if tumour was >50 mm and/or for location if the tumour was Type II, III or IV sec. Privette/Al-Thani classification.
Between May 2010 and February 2017, 12 consecutive patients underwent robot-assisted treatment of GIST at our institution. DCs were 10/12 cases (83.3%), of which 6/10 (50%) for location, 2/10 (25%) for size and 2/10 (25%) for both. The da Vinci Si was used in 8 patients, of which 6 (75%) were DC, and the da Vinci Xi in 4, all of which (100%) were DC. In all patients, excision was by wedge resection. All lesions had microscopically negative resection margins. There was no conversion to open surgery, no tumour ruptures or spillage and no intraoperative complications.
Our experience suggests a positive role of the robot da Vinci in getting gastric GIST removal with a conservative approach, regardless of size and location site. Comparative studies with a greater number of patients are necessary for a more robust assessment.
胃胃肠道间质瘤（GIST）微创手术的作用仍不明确，尤其是对于大的和/或位置困难的肿瘤。我们在此展示一组使用达芬奇手术系统（Si或Xi）进行机器人辅助切除的单中心病例系列。
从前瞻性收集的机构数据库中检索接受机器人辅助治疗胃GIST患者的数据，并进行回顾性分析。根据肿瘤的大小和位置对患者进行分层。如果肿瘤>50mm，则考虑大小为困难病例（DC）；如果肿瘤为Privette/Al-Thani分类的II型、III型或IV型，则考虑位置为困难病例。
2010年5月至2017年2月期间，我院连续12例患者接受了机器人辅助的GIST治疗。困难病例为10/12例（83.3%），其中因位置为困难病例的有6/10（50%），因大小为困难病例的有2/10（25%），因两者均为困难病例的有2/10（25%）。8例患者使用了达芬奇Si系统，其中6例（75%）为困难病例；4例患者使用了达芬奇Xi系统，所有病例（100%）均为困难病例。所有患者均采用楔形切除术。所有病变的显微镜下切缘均为阴性。无中转开腹手术，无肿瘤破裂或溢出，无术中并发症。
我们的经验表明，达芬奇机器人在以保守方法切除胃GIST方面具有积极作用，无论肿瘤大小和位置如何。需要进行更多患者的比较研究以进行更有力的评估。
