Near-infrared fluorescence clip guided robot-assisted wedge resection of a gastric submucosal tumour: A case report

BACKGROUND: The conventional near-infrared fluorescence clip (NIRFC): ZEOCLIP FS®, was difficult to observe using the Firefly on da Vinci. We improved the ZEOCLIP FS® and produced the da Vinci compatible NIRFC. In this report, we describe a robot-assisted wedge resection of a submucosal tumour (SMT) of the stomach using the da Vinci compatible NIRFC. PRESENTATION OF CASE: Surgery was performed for an enlarging SMT (from 18 to 22 mm with an intragastric growth type). Through endoscopy, four da Vinci-compatible NIRFCs were placed at the tumour edge two days prior to the surgery. The location of the NIRFC was confirmed when observed with the Firefly. The distal NIRFC site was incised with a monopolar shear blade to identify the NIRFCs and tumour base. The open area was sutured in two layers using a 3-0 V-Loc. The operation time was 83 min, and the amount of blood loss was 2 g. There were no complications or clip dropout. DISCUSSION: This method could be performed without intraoperative endoscopist. CONCLUSION: In this case, we were able to observe the position of the da Vinci-compatible NIRFC with Firefly on da Vinci. This technique may be an option as a simple procedure to minimize the resection area of the stomach.