Wedge gastrectomy: Robot-assisted with a hand-sewn repair versus a laparoscopic linear stapler technique for gastric subepithelial tumors

Abstract

Objective: Minimally invasive surgery has become common in surgical resections of gastric subepithelial tumors. An endostapler technique is simple and easy to perform when cutting the stomach. Gastrotomy using a hand-sewn repair is a new approach for identifying and removing gastric subepithelial tumors, but few studies have evaluated its efficacy. In this study, we demonstrated the safety and effectiveness of this novel technique using a robot-assisted approach. Materials and methods: A retrospective cohorts of all patients who presented with gastric subepithelial tumors and underwent robotic or laparoscopic resection at Ramathibodi Hospital from 2012 to 2018 was reviewed. Surgical outcomes and complications of the robot-assisted approach with a hand-sewn repair were analyzed and compared to those of the laparoscopic linear stapler technique. Results: In total, 25 patients were included in this study. Most of the subepithelial tumors were gastrointestinal stromal tumors (17 patients, 68%). Ten patients (40%) underwent a robot-assisted procedure with a hand-sewing technique, and 15 patients underwent a laparoscopic linear stapler procedure. Mean tumor size was 3.79 ± 1.35 cm in the robot-assisted procedure with a hand-sewing technique group and 3.52 ± 1.88 cm in the laparoscopic linear stapler procedure group. The former experienced a longer operative time (261 ± 54 vs 144 ± 64 minutes, p < 0.001) and a longer time to return to a normal diet (5.7 ± 2.0 vs 4.0 ± 1.4 days, p = 0.028). Neither group experienced perioperative complications or mortality. Conclusion: Although the time to return to a normal diet and operative time were significantly longer compared to a laparoscopic procedure using a linear stapler, the robot-assisted approach using a hand-sewn repair for gastric subepithelial tumors is feasible, effective, and safe. This can be an alternative for the surgical treatment of gastric subepithelial lesions. Keywords: Gastric subepithelial tumor, Gastrointestinal stromal tumor, Gastrotomy with a hand-sewn repair, Robot-assisted surgery, Laparoscopic surgery