- Robotic Small Bowel Gastrointestinal Stromal Tumor Resection Using Indocyanine Green Perfusion Assessment and Intracorporeal Anastomosis
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Nathan Aminpour, Jay N. Patel, Niharika Kareddy, Elisabeth C. McLemore
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Received May 6, 2026 Accepted June 28, 2026 Published online August 20, 2026
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DOI: https://doi.org/10.69474/jsie.2026.00094
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 Abstract
- Small bowel gastrointestinal stromal tumors (GISTs) account for 20%–30% of GISTs and are associated with more aggressive behavior than gastric lesions. Standard treatment for localized disease is R0 surgical resection with negative margins. Minimally invasive approaches have demonstrated oncologic outcomes comparable to those of open surgery, but technical descriptions of robotic resection incorporating adjunctive fluorescence imaging and intracorporeal anastomosis remain limited. This retrospective case review describes minimally invasive robotic small bowel GIST resection using indocyanine green (ICG) fluorescence to guide intraoperative perfusion assessment. Institutional review board authorization was obtained. Data on clinical presentation, diagnostic evaluation, operative technique, and postoperative outcomes were reviewed and used to prepare this case report. A 67-year-old man presented with abdominal discomfort and weight loss. Clinical workup included cross-sectional imaging, which showed a 3.9-cm distal small bowel mass without lymphadenopathy. The patient underwent endoscopic evaluation, which localized a proximal jejunal subepithelial lesion and included tattoo placement. Minimally invasive robotic surgical resection was performed. After mesenteric division, ICG near-infrared fluorescence confirmed adequate perfusion of the planned transection margins. A side-to-side functional end-to-end enteroenterostomy was completed intracorporeally, and the specimen was extracted in a protective specimen bag. The patient recovered without complications and was discharged on postoperative day 1. Pathology revealed a 3.9-cm low-grade spindle-cell GIST with negative margins. Robotic minimally invasive resection of a symptomatic small bowel GIST with intracorporeal anastomosis was feasible and consistent with established oncologic principles. ICG fluorescence imaging provided real-time perfusion assessment. Early multidisciplinary collaboration and selective diagnostic evaluation may help streamline care. This case illustrates the integration of advanced robotic platforms and fluorescence-guided near-infrared imaging in the management of small bowel GIST while maintaining adherence to established oncologic principles.
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