In September 2016, a 74-year male was admitted into the Department of Gastrointestinal Surgery due to the symptom of dysphagia. Preoperative examinations diagnosed cardia gastric carcinoma and a synchronous 4-cm mass in the body of pancreas. For the sake of curative intention, a radical D2 total gastrectomy plus pancreaticosplenectomy was required. Compared with a minimally invasive surgery, a conventional open surgery might cause greater trauma and prolonged recovery. Based on the multidisciplinary team of gastric cancer, a da Vinci robot-assisted surgery with minimal incision was planned for the patient.

Prof. Jian-Kun Hu, from the Department of Gastrointestinal Surgery, completed the mobilization and D2 lymphadenectomy via the da Vinci robot, while the resection of stomach and reconstruction of digestive tract was done through a minimal incision. Meanwhile, Prof. Bo-Le Tian, from the Department of Pancreatic Surgery, cooperated and successfully completed the pancreaticosplenectomy through the minimal incision. The intraoperative blood loss was merely 100 ml. Postoperative pathological tests demonstrated pT4aN3aM0 disease for cardia gastric cancer and grade 2 neuroendocrine tumor for the pancreatic mass.

Since January 2016, Prof. Hu has performed 15 da Vinci robot-assisted D2 gastrectomies for gastric cancers, including the first of distal gastrectomy and the first total gastrectomy in Sichuan province. Besides, the procedure of da Vinci robot-assisted total gastrectomy with splenic hilar lymphadenectomy was first reported in domestic literatures in China. The present case of da Vinci robot-assisted total gastrectomy plus pancreaticosplenectomy was also absent in international literatures.

Written by: Xin-Zu Chen, Wei-Han Zhang, Xiao Du, Department of Gastrointestinal Surgery