Robotic resection of a giant gastrointestinal stromal tumor (gist): a path we dared to take

Gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors (0.1% to 3% of malignant GI
tumors). They are most commonly found in the stomach (>60%), small intestine (25–30%) and colon
(5–15%)(2,3). Surgical resection is the primary approach for localized GIST. Surgical R0 resection of
GIST without metastases is the only promising treatment for a permanent cure. GIST larger than 10 cm
are usually treated by open surgery, while minimally invasive procedures are indicated for small GIST.
This video demonstrates a robotic resection of a giant gastric GIST. A 48-year-old man presented with
a large abdominal mass discovered during a routine ultrasound examination. Further imaging revealed a
voluminous tumor measuring 20 by 18 centimeters in the upper left quadrant, displacing adjacent structures
such as the transverse colon, pancreas and spleen. An endoscopic ultrasound biopsy confirmed the diagnosis of GIST). The patient was treated with imatinib for 18 months and responded well. A
multidisciplinary team recommended surgical resection. A robotic approach was proposed and consent
was obtained.