Abstract
To investigate the safety and efficiency of using robotic staplers for intracorporeal gastroduodenostomy in reduced-port robotic gastrectomy for gastric adenocarcinoma. We retrospectively reviewed patients who underwent totally robotic and laparoscopic gastrectomy with intracorporeal gastroduodenostomy. Gastroduodenostomy using the ENDOWRIST robotic stapler (RR) was compared to that using an endolinear stapler during robotic gastrectomy (RE) and to that using an endolinear stapler during laparoscopic gastrectomy (LE). A total of 296 patients underwent gastroduodenostomy: 58, 28, and 210 patients with RR, RE, and LE, respectively. There were no conversions to other methods, and all robotic stapling procedures were performed on the console without receiving additional assistance from a bedside surgeon during RR. Comparing the operative outcomes of RR with those of RE and LE, respectively, we noted similar postoperative short-term outcomes. There were no major complications, including anastomosis-related complications, during the postoperative period after RR. The median reconstruction time during RR was 8 min and 45 s, which was similar to that during RE (8 min, 5 s [P > 0.9999]), but longer than that during LE (6 min, 30 s [P < 0.0001]). Intracorporeal gastroduodenostomy using the robotic stapler during robotic gastrectomy could be safely and feasibly performed on the console without the assistance of assistant, bedside surgeons.
Highlights
To investigate the safety and efficiency of using robotic staplers for intracorporeal gastroduodenostomy in reduced-port robotic gastrectomy for gastric adenocarcinoma
Groups robotic stapler (RR) and robotic gastrectomy (RE) showed no significant differences in age, sex, American Society of Anesthesiologists (ASA) classification, body mass index (BMI), cT and cN classification, and tumor location
We demonstrated that robotic ENDOWRIST staplers, which can be fully controlled by the surgeon at the console, can be safely and efficiently applied for performing intracorporeal delta-shaped gastroduodenostomy, which is regarded as a technically demanding procedure, during robotic distal gastrectomy without the need for assistance from an assistant, bedside surgeon
Summary
To investigate the safety and efficiency of using robotic staplers for intracorporeal gastroduodenostomy in reduced-port robotic gastrectomy for gastric adenocarcinoma. We retrospectively reviewed patients who underwent totally robotic and laparoscopic gastrectomy with intracorporeal gastroduodenostomy. There were no conversions to other methods, and all robotic stapling procedures were performed on the console without receiving additional assistance from a bedside surgeon during RR. Intracorporeal gastroduodenostomy using the robotic stapler during robotic gastrectomy could be safely and feasibly performed on the console without the assistance of assistant, bedside surgeons. One recent advance in minimally invasive surgery for gastric cancer is totally minimally invasive gastrectomy, in which all procedures, including anastomosis, are performed intracorporeally. We sought to develop a method for intracorporeal gastroduodenostomy that is safe and can be performed with less effort during gastric cancer surgery, including robotic g astrectomy[9]. An assistant surgeon who stands over the patient is needed to control laparoscopic endolinear staplers[11]. The role of and cooperation with the assistant surgeon for anastomosis are crucial
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