Abstract
BackgroundRobotic surgery has been developed with the aim of improving surgical quality and overcoming the limitations of conventional laparoscopy in the performance of complex mini-invasive procedures. The present study was designed to compare robotic and laparoscopic distal gastrectomy in the treatment of gastric cancer.MethodsBetween June 2008 and September 2015, 41 laparoscopic and 30 robotic distal gastrectomies were performed by a single surgeon at the same institution. Clinicopathological characteristics of the patients, surgical performance, postoperative morbidity/mortality and pathologic data were prospectively collected and compared between the laparoscopic and robotic groups by the Chi-square test and the Mann-Whitney test, as indicated.ResultsThere were no significant differences in patient characteristics between the two groups. Mean tumor size was larger in the laparoscopic than in the robotic patients (5.3 ± 0.5 cm and 3.0 ± 0.4 cm, respectively; P = 0.02). However, tumor stage distribution was similar between the two groups. The mean number of dissected lymph nodes was higher in the robotic than in the laparoscopic patients (39.1 ± 3.7 and 30.5 ± 2.0, respectively; P = 0.02). The mean operative time was 262.6 ± 8.6 min in the laparoscopic group and 312.6 ± 15.7 min in the robotic group (P < 0.001). The incidences of surgery-related and surgery-unrelated complications were similar in the laparoscopic and in the robotic patients. There were no significant differences in short-term clinical outcomes between the two groups.ConclusionsWithin the limitation of a small-sized, non-randomized analysis, our study confirms that robotic distal gastrectomy is a feasible and safe surgical procedure. When compared with conventional laparoscopy, robotic surgery shows evident benefits in the performance of lymphadenectomy with a higher number of retrieved and examined lymph nodes.
Highlights
Robotic surgery has been developed with the aim of improving surgical quality and overcoming the limitations of conventional laparoscopy in the performance of complex mini-invasive procedures
The development of laparoscopic surgery for gastric cancers in the Western world has been slow because most gastric cancers are diagnosed in an advanced stage for which laparoscopic gastrectomy is not yet considered an acceptable alternative to standard open surgery [8, 9]
It is believed that this technological evolution can assist the surgeon with complex surgical procedures that are required in radical gastrectomy, such as precise lymph node dissection and intracorporeal anastomoses [14]
Summary
Robotic surgery has been developed with the aim of improving surgical quality and overcoming the limitations of conventional laparoscopy in the performance of complex mini-invasive procedures. The development of laparoscopic surgery for gastric cancers in the Western world has been slow because most gastric cancers are diagnosed in an advanced stage for which laparoscopic gastrectomy is not yet considered an acceptable alternative to standard open surgery [8, 9]. This skepticism is basically due to the technical complexity of laparoscopic gastrectomy and concerns the feasibility of an oncologically acceptable lymphadenectomy. It is believed that this technological evolution can assist the surgeon with complex surgical procedures that are required in radical gastrectomy, such as precise lymph node dissection and intracorporeal anastomoses [14]
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