V62 - Robotic Excision of an Extra-Rectal Gastrointestinal Stromal Tumor (GIST)

CME Eligible

Purpose/Background: This video demonstrates a robotic-assisted excision of an Extra-Rectal Gastrointestinal Stromal Tumor (GIST), detailing steps from patient positioning to specimen retrieval. The procedure highlights the application of robotic technology to colorectal oncology with a focus on oncologic principles and functional preservation.

Methods/Interventions: Using a multiport robotic platform, the procedure emphasizes precise mesorectal dissection. Key technical steps include pelvic-optimized port placement, early GIST identification through transanal and transabdominal views, and en bloc resection with negative margins while preserving sphincter function. Articulating robotic instruments enable sharp dissection, hemostasis, and careful ureteral sparing where appropriate. The rectal wall defect is closed and reconstructed securely to reduce anastomotic risk, and the specimen is retrieved intact in a protective bag.

Results/Outcomes: The tumor was resected en bloc with negative margins, with partial prostatectomy performed to ensure complete excision. A partial-thickness anterior rectal injury was repaired primarily, and intraoperative sigmoidoscopy confirmed mucosal integrity. The patient recovered uneventfully and was discharged on postoperative day 2. Final pathology revealed a 7 cm pT3 GIST, C-KIT, DOG1, and CD34 positive, with no invasion of adjacent structures. One-year surveillance imaging and colonoscopy showed no recurrence, and the patient remains on adjuvant Imatinib with planned continuation for five years.

Conclusion/Discussion: This technique demonstrates the value of robotic surgery in the pelvis, with enhanced 3D visualization, tremor reduction, and increased dexterity enabling precise tumor resection and reduced tissue trauma. Robotic platforms may improve outcomes in select patients with Extra-Rectal GISTs.