Gastritis cystica profunda (GCP) has been defined as a rare submucosal benign gastric lesion with cystic gland growth. Due to its unclear etiopathogenesis, this lesion is often misdiagnosed and mistaken for other gastric masses. Currently, a standardized treatment for GCP lesions is still missing. Here, we illustrate a case of a patient admitted to our general surgery department for melena and general discomfort. No history of peptic ulcer or gastric surgery was present. Upper GI endoscopy was performed, showing a distal gastric lesion with a small ulceration on the top. CT-scan and endoscopic ultrasound confirmed the presence of the lesion, compatible with a gastric stromal tumor, without showing any eventual metastasis. Surgical gastric resection was performed. Histological findings were diagnostic for GCP, with cistically ectasic submucosal glands, chronic inflammation, eosinophilic infiltration and foveal hyperplasia. GCP is a very exceptional cause of upper-GI bleeding with specific histological features. Its diagnosis as well as its therapy are challenging, resulting in several pitfalls. Even though it is a rare entity, GCP should always be considered in the differential diagnosis of gastric submucosal lesions.

Surgical resection with total mesorectal excision (TME) represents a crucial milestone in the treatment of rectal cancer. Conventional open procedures have been gradually replaced by minimally invasive techniques. To date, laparoscopic and robotic resection associated with neoadjuvant chemo-radiotherapy, represent the gold standard for rectal malignancies. Robotic surgery, when performed by an experienced surgeon, can offer advantages in case of difficult anatomical conditions, such as in male patients with a narrow pelvis. Higher costs remain a matter of debate in the diffusion of robotic platforms in general surgery. However, encouraging surgical outcomes and a shorter learning curve for the surgeon counterbalance the associated expense. Different surgical approaches are available for rectal cancer, according to the extension of the tumor and its location. The cornerstone of the different approaches is represented by TME, both transabdominally and transanally. Adequate TME, associated with neoadjuvant therapy, is pivotal in the success of the oncological treatment, in terms of curative results and reduced recurrence. Current different approaches are low anterior resection, abdominoperineal resection, and intersphincteric resection. They can all be performed with the robotic system and their surgical steps are described in this chapter.

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