A novel transoral extraction technique in robotic resection of gastroduodenal tumors: a case series

Robotic-assisted resection of non-adenocarcinoma gastroduodenal tumors offers equivalent oncologic safety while preserving the benefits of minimally invasive surgery. Transoral extraction augments these benefits by reducing the need for a larger extraction incision. This study explores the feasibility of endoscopic transoral extraction of robotically resected gastroduodenal tumors. Patients underwent robotic gastroduodenal tumor resection by an experienced robotic surgeon. Resected specimens were secured in an EndoCatch bag and retrieved transorally using an upper gastrointestinal endoscope. Five patients (median age 46 years, 40% female) were included. Patients were ASA class II/III. Tumor sizes ranged from 2.1 to 9.0 cm, located at the gastroesophageal junction, gastric fundus, lesser curvature, and proximal duodenum. Pathological diagnoses included leiomyoma, gastrointestinal stromal tumor (GIST), and glomus tumor. Robotic resection utilized 8-mm abdominal ports. No intraoperative adverse events occurred, and all specimens were retrieved intact. The median console time was 94 min, and 80% of cases had estimated blood loss of less than 20 cc. The median hospital stay was two days. Most patients (80%) resumed clear liquid diet by postoperative day one and progressed to full-liquid diet by day two. No patients required narcotics for postoperative pain management, with 80% managed with oral acetaminophen alone. No esophageal or oropharyngeal complications, readmissions, mortality, or incisional hernias occurred during the follow-up. This case series demonstrates the technical feasibility of robotic-assisted resection of gastroduodenal tumors with structured transoral extraction using real-time endoscopic guidance, representing a technical extension of established NOSES principles in the robotic surgery setting. Prospective multicenter studies are needed to validate safety and broader applicability.