Robot-assisted Distal Gastrectomy Research Articles

Duplicate left gastric artery identified during robot-assisted distal gastrectomy: a case report

BackgroundDuplicated left gastric artery (LGA) is a rare anomaly. With an incidence of only 0.4%, its clinical significance remains largely unrecognized.Case presentationA 65-year-old man underwent robot-assisted distal gastrectomy for early gastric cancer. After division of the left gastric vein in the left gastropancreatic fold, a slim LGA (LGA-1) was identified and dissected. Careful dissection of the left gastropancreatic fold toward the root of the celiac artery revealed another LGA (LGA-2), which was dissected without difficulty. Postoperative reevaluation of the three-dimensional-computed tomography (CT) angiography reconstructed using the preoperative CT scan identified a 2.7 mm LGA-1, branching from the splenic artery, and a 3.0 mm LGA-2, branching from the celiac artery. To the best of our knowledge, this is only the third reported case of a duplicate LGA in a patient who underwent laparoscopic gastrectomy. Our case is the first to report the use of robot surgery.ConclusionsAlthough duplicate LGA is rare and receives little clinical attention, surgeons should keep this vascular anomaly in mind during preoperative evaluation since there is an increased risk for intraoperative bleeding during gastrectomy.

Safety and efficacy of robotic-assisted versus laparoscopic distal gastrectomy after neoadjuvant chemotherapy for advanced gastric cancer.

Robot-assisted distal gastrectomy (RADG) has been used in the minimally invasive surgical treatment of gastric cancer, but the research on advanced gastric cancer (AGC) after neoadjuvant chemotherapy (NAC) has not been reported. This study aimed to analyze the outcomes of RADG versus laparoscopic distal gastrectomy (LDG) after NAC for AGC. This was a retrospective propensity score-matched analysis from February 2020 and March 2022. Patients who underwent RADG or LDG for AGC (cT3-4a/N +) following NAC were enrolled and a propensity score-matched analysis was performed in a 1:1 manner. The patients were divided into RADG group and LDG group. The clinicopathological characteristics and short-term outcomes were observed. After propensity score matching, 67 patients each in the RADG and LDG groups. RADG was associated with a lower intraoperative blood loss (35.6 vs. 118.8ml, P = 0.014) and more retrieved lymph nodes (LNs) (50.7 vs. 39.5, P < 0.001), more extraperigastric (18.3 vs. 10.4, P < 0.001), and suprapancreatic LNs (16.33 vs. 13.70, P = 0.042). The RADG group showed lower VAS scores at postoperative 24h (2.2 vs 3.3, P = 0.034), earlier ambulation (1.3 vs. 2.6, P = 0.011), aerofluxus time (2.2 vs. 3.6, P = 0.025), and shorter postoperative hospital stay (8.3 vs. 9.8, P = 0.004). There were no significant differences in the operative time (216.7 vs.194.7min, P = 0.204) and postoperative complications between the two groups. RADG may be a potential therapeutic option for patients with AGC after NAC considering its advantages in perioperative period compared with LDG.

Robot-assisted distal gastrectomy for duodenal gastrointestinal stromal tumors adhering to the pancreas: a case report.

Duodenal gastrointestinal stromal tumors (D-GISTs) are uncommon and account for 3-5% of all GISTs. Currently, no established surgical strategy for D-GISTs exists, which mostly depends on tumor size, relation to the ampulla and invasion of the adjacent organ. We report a case of large D-GIST resected by robotic distal gastrectomy. A 62-year-old woman was diagnosed with a 5-cm D-GIST located at posterior wall of the duodenal bulb. Computed tomography findings indicated possible tumor invasion of the pancreas head. Robot-assisted distal gastrectomy was firstly planned and pancreatoduodenectomy was also considered when the tumor was invading to the pancreas. Although tumor was tightly adherent to the pancreas, it could be dissected from the pancreatic head without capsule damage and resected by robotic distal gastrectomy with no postoperative complication. The large D-GIST tightly adherent to the pancreas could be resected by efficiency of the robotic surgery.

Initial experience of single-incision robotic surgery for distal gastrectomy with da Vinci Xi platform

BackgroundThe aim of this study was to describe technical considerations and short-term outcomes from the first reported single-incision robotic operation for distal gastrectomy with the use of da Vinci Xi surgical system. MethodsA 71-year-old patient with a body-mass index of 22.4 ​kg/m2 was treated for a gastrointestinal stromal tumor(GIST) in the posterior wall of the gastric antrum by single-incision robot-assisted distal gastrectomy with the da Vinci Xi robotic system on September 17, 2022 in Shanghai General Hospital. ResultsThe single-incision da Vinci Xi robot-assisted distal gastrectomy was successfully performed with intraperitoneal Billroth Ⅱ anastomosis. The console time among the operation was 100 ​min with 10 ​ml of intraoperative blood loss. The patient was put on a liquid diet the next day after surgery and discharged on postoperative day 4. During the postoperative period, no severe adverse events occurred. The final pathology revealed a low-risk gastrointestinal stromal tumor (GIST) with a size of 5.0 ​× ​3.5 ​× ​2.5 ​cm. ConclusionSingle-incision da Vinci Xi robot-assisted distal gastrectomy was a safe and feasible surgical method for patients with gastric tumor. The study filled in the corresponding research gaps and provided a basis for subsequent research. To verify its superior operative outcomes, further clinical trials are needed.

Surgical and short-term outcomes in robotic and laparoscopic distal gastrectomy for gastric cancer with enhanced recovery after surgery protocol: A propensity score matching analysis.

ObjectiveThis study aims to evaluate the short-term surgical outcomes of laparoscopy-assisted distal gastrectomy (LADG) and robot-assisted distal gastrectomy (RADG) for gastric cancer (GC) with enhanced recovery after surgery (ERAS) protocols.MethodsWe reviewed the medical records of 202 patients undergoing radical distal gastrectomy; among them, 67 cases were assisted through RADG, while 135 cases were assisted through LADG along with ERAS. We retrospectively collected the medical records in succession from a database (January 2016–March 2019). We adopted propensity score matching to compare surgical and short-term outcomes of both groups.ResultsAfter the successful examination of 134 cases, including 67 receiving RADG and 67 undergoing LADG, the operative times were noted as 5.78 ± 0.96 h for the RADG group and 4.47 ± 1.01 h for the LADG group (P < 0.001). The blood loss was noted as 125.52 ± 101.18 ml in the RADG group and 164.93 ± 109.32 ml in the LADG group (P < 0.05). The shorter time to first flatus was 38.82 ± 10.56 h in the RADG group and 42.88 ± 11.25 h in the LADG group (P < 0.05). In contrast, shorter days of postoperative hospital stay were 5.94 ± 1.89 days in the RADG group and 6.64 ± 1.92 days in the LADG group (P < 0.05). Also, the RADG group (84483.03 ± 9487.37) was much more costly than the LADG group (65258.13 ± 8928.33) (P < 0.001). The postoperative overall complication rates, numbers of dissected lymph nodes, visual analogue scale (VAS), and time to start a liquid diet for the RADG group and the LADG group were similar.ConclusionsIn this research, we concluded that RADG provides surgical benefits and short-term outcomes compared to LADG for GC with ERAS.

Surgical and oncological outcomes of robotic- versus laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer: a propensity score‑matched analysis of 1164 patients

BackgroundStudies on surgical outcomes after robotic surgery are increasing; however, long-term oncological results of studies comparing robotic-assisted distal gastrectomy (RADG) versus laparoscopic-assisted distal gastrectomy (LADG) for advanced gastric cancer (AGC) are still limited. This study aimed to assess the surgical and oncological outcomes of RADG and LADG for the treatment of AGC.MethodsA total of 1164 consecutive AGC patients undergoing RADG or LADG were enrolled between January 2015 and October 2021. Propensity score-matched (PSM) analysis was performed to minimize selection bias. The perioperative and oncological outcomes between the two groups were compared.ResultsPatient’s characteristics were comparable between the two groups after PSM. RADG group represented a longer operative time (205.2 ± 43.1 vs 185.3 ± 42.8 min, P < 0.001), less operative blood loss (139.3 ± 97.8 vs 167.3 ± 134.2 ml, P < 0.001), greater retrieved lymph nodes (LNs) number (31.4 ± 12.1 vs 29.4 ± 12.3, P = 0.015), more retrieved LNs in the supra-pancreatic areas (13.4 ± 5.0 vs 11.4 ± 5.1, P < 0.001), and higher medical costs (13,608 ± 4326 vs 10,925 ± US $3925, P < 0.001) than LADG group. The overall complication rate was 13.7% in the RADG group and 16.6% in the LADG group, respectively; the difference was not significantly different (P = 0.242). In the subgroup analysis, the benefits of RADG were more evident in high BMI patients. Moreover, the 3-year overall survival (75.5% vs 73.1%, P = 0.471) and 3-year disease-free survival (72.9% vs 71.4%, P = 0.763) were similar between the two groups.ConclusionRADG appears to be a safe and feasible procedure and could serve as an alternative treatment for AGC in experienced centers.

Totally Robotic Distal Gastrectomy: A Safe and Feasible Minimally Invasive Technique for Gastric Cancer Patients Who Undergo Distal Gastrectomy

Purposes: To explore the safety and feasibility of totally robotic distal gastrectomy (TRDG) for gastric cancer patients who undergo distal gastrectomy. Methods: Consecutive patients with gastric cancer who underwent TRDG (TRDG group) and robotic-assisted distal gastrectomy (RADG) (RADG group) were systematically reviewed at the Second Xiangya Hospital of Central South University from October 2015 to August 2018. Data were collected and statistically analyzed. Results: A total of 161 consecutive patients were included in this study: 84 cases in the TRDG group and 77 in the RADG group. Clinical characteristics and pathological results were mostly similar in both groups. The TRDG group had a significantly longer anastomotic time (20.6 ± 3.3 vs. 17.5 ± 4.0 min, p ˂ 0.001) but showed no difference in total operating time (167.0 ± 18.0 vs. 162.9 ± 17.6 min, p = 0.159). The postoperative hospitalization in the TRDG group was shorter than that in the RADG group (6.7 ± 1.2 vs. 7.2 ± 1.7 days, p = 0.019). Conversion rate, estimated blood loss, and postoperative complications were similar in both groups. There were no statistical differences in the estimated 2-year disease-free survival and overall survival rate between both groups. Conclusions: Although our current results need to be verified in further studies, TRDG represents a safe and feasible approach to distal gastrectomy and embodies the theory of minimally invasive surgery.

Fluoroscopic balloon dilation for early jejunojejunostomy obstruction after gastrectomy with roux-en-Y reconstruction: a case series of three patients

BackgroundSmall bowel obstruction after gastrectomy with Roux-en-Y reconstruction (R-Y reconstruction) is not a rare complication. However, patients who need re-operation for this complication have a high rate of postoperative complications.We report a case series of three patients who underwent fluoroscopic balloon dilation (FBD) for early jejunojejunostomy obstruction (JJO) after gastrectomy with Roux-en-Y reconstruction (R-Y reconstruction).Case presentationThree patients were referred to our hospital for surgery for gastric cancer. Robot-assisted distal gastrectomy with D2 lymph node dissection and antecolic R-Y reconstruction were performed in two patients, and robot-assisted total gastrectomy with D1+ lymph node dissection and antecolic R-Y reconstruction was performed in one patient. The jejunojejunostomy was created as a side-to-side anastomosis using a linear 45-mm stapler. The entry hole was closed with a knotless barbed suture, and serosal-muscle layer suture reinforcement with an absorbable suture was performed at the jejunojejunostomy.Subsequently, all the patients were diagnosed with JJO by computed tomography and upper gastrointestinal series. The average time to JJO from gastrectomy was 5 days (range 2–7); initial clinical symptoms were vomiting in all three cases, with simultaneous upper abdominal pain in one case. We successfully performed FBD in all three cases after unsuccessful conservative treatment using an ileus tube. The clinical symptoms improved soon after FBD, and all the patients were able to avoid re-operation. The average period to FBD from JJO was 10 days (range 4–14). The average procedure time was 46 min (range 29–68), and the average duration to oral intake from FBD was 4 days (range 2–5). The average duration of hospital stay after FBD was 12 days (range 9–15). There were no complications in any of the cases.ConclusionFBD might be a feasible procedure to avoid surgery for early small bowel obstruction after gastrectomy with R-Y reconstruction.

Robotic- versus laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer based on propensity score matching: short-term outcomes at a high-capacity center

Reports in the field of robotic surgery for gastric cancer are increasing. However, studies only on patients with advanced gastric cancer (AGC) are lacking. This retrospective study was to compare the short-term outcomes of robotic-assisted distal gastrectomy (RADG) and laparoscopic-assisted distal gastrectomy (LADG) with D2 lymphadenectomy for AGC. From December 2014 to November 2019, 683 consecutive patients with AGC underwent mini-invasive assisted distal gastrectomy. Propensity-score matching (PSM) analysis was conducted to reduce patient selection bias. Short-term outcomes were compared between the two groups. The clinical features were well matched in the PSM cohort. Compared with the LADG group, the RADG group was associated with less operative blood loss, a lower rate of postoperative blood transfusion, less volume of abdominal drainage, less time to remove abdominal drainage tube, retrieved more lymph node, and lower rates of surgical complications and pancreatic fistula (P <0.05). However, the time to recovery bowel function, the length of postoperative stay, the rates of other subgroups of complications and unplanned readmission were similar between the two groups (P > 0.05). This study suggests that RADG is a safe and feasible technique with better short-term outcomes than LADG for AGC.

Systematic assessment of complications after robotic-assisted total versus distal gastrectomy for advanced gastric cancer: A retrospective propensity score-matched study using Clavien-Dindo classification.

Despite increasing evidence demonstrated robot-assisted distal gastrectomy (RADG) is safe and feasible for the treatment of advanced gastric cancer (AGC), robot-assisted total gastrectomy (RATG) remains a challenging procedure due to its technical difficulties and possible postoperative complications (POCs). This study aimed to systematically evaluate POCs following RATG. Between January 2017 and January 2019, 319 AGC patients with pathological stage T2-4aN0-3M0 who underwent RADG or RATG were enrolled. POCs were stratified using the Clavien-Dindo classification. One-to-one propensity score matching was performed to reduce confounding differences. After matching, 266 patients met the criteria for further analysis. Ultimately, 64 patients (24.1%) who developed POCs had 126 clinical manifestation events. Overall the POCs rate was significantly greater after RATG in comparison with RADG (29.3% vs. 18.8%; P = 0.045), and more major POCs (Clavien-Dindo grade ≥ IIIa) were observed in the RATG group (14.3% vs. 5.3%; P = 0.013). The POCs were then classified into local and systemic POCs. The rates of local POCs (35.3% vs. 19.5%; P = 0.004) and systemic POCs (24.8% vs. 15.0%; P = 0.046) were significantly higher in the RATG group than the RADG group. Subgroup analysis showed that the anastomotic leakage rate was higher after RATG (5.3% vs. 0.8%; P = 0.031), whereas the remaining POCs were similar between the two groups. Patients with higher POCs significantly had longer postoperative length of stay (R = 0.895, P = 0.003). Multivariate analysis confirmed age, extent of resection, and TNM stage were risk factors for all POCs. These findings demonstrated that RATG is technically feasible and safe for treatment of AGC with acceptable morbidity and mortality rates. The POCs rate of RATG was higher than RADG, especially for anastomotic leakage. More effective anastomotic techniques are needed in RATG to prevent leakage.

Learning curve of Da Vinci robot-assisted radical gastrectomy for gastric cancer

Objective To investigate the learning curve of Da Vinci robot-assisted laparoscopic radical gastrectomy for gastric cancer. Methods The retrospective cohort study was conducted. The clinicopathological data of 42 patients who underwent Da Vinci robot-assisted radical gastrectomy for gastric cancer in the First Affiliated Hospital of Xi′an Jiaotong University from October 2017 to August 2018 were collected. There were 30 males and 12 females, aged from 36 to 84 years, with an average age of 59 years. The learning curve was evaluated using the cumulative sum (CUSUM) analysis and the best fitting curve method. According to the minimum number of surgeries required to cross the learning curve, the patients were divided into learning stage group and mastery stage group. Then general data and surgical efficacy of the two groups were compared. Observation indicators: (1) surgical situations; (2) results of CUSUM analysis; (3) comparison of general data between the two groups; (4) comparison of surgical efficacy between the two groups; (5) follow-up. Patients were followed up by outpatient examination or telephone interview to detect the postoperative complications, tumor recurrence and metastasis up to February 2019. Measurement data with normal distribution were presented as Mean±SD, and comparison between groups was done using the independent sample t test. Count data were represented as absolute number, and comparison between groups was analyzed using the chi-square test or Fisher exact propability. Comparison of ordinal data between groups was analyzed using the Mann-Whitney U test. Results (1) Surgical situations: all the 42 patients underwent Da Vinci robot-assisted radical gastrectomy for gastric cancer successfully, without conversion to open surgery or perioperative death. Fourteen out of 42 patients underwent Da Vinci robot-assisted total radical gastrectomy and 28 underwent Da Vinci robot-assisted distal radical gastrectomy. The operation time and docking time were (213±31)minutes and (26±11)minutes. The operation time and docking time had a tendency to decreasing as the surgical cases increasing. (2) Results of CUSUM analysis. The CUSUM learning curve were best modeled as a polynomial with equation: CUSUM (operation time)=0.016 9X3-1.913 3X2+ 50.985X-16.595, CUSUM(docking time)=0.012 8X3-1.070 7X2+ 22.189X-23.097 respectively (X means the surgical case). The P value of fitting test of models was 0.05). There was no significant difference in the previous abdominal surgery history between the two groups (P>0.05). (4) Comparison of surgical efficacy between the two groups: operation time, volume of intraoperative blood loss, number of lymph nodes harvested, time to first liquid food intake, cases with postoperative complications and duration of postoperative hospital stay were (230±25)minutes, (176±103)mL, 21±7, (5.1±2.0)days, 2, (9.3±2.5)days in the learning stage group, and (191±18)minutes, (95±41)mL, 21±6, (4.7±1.7)days, 3, (8.4±2.1)days in the mastery stage group, respectively. There were statistically significant differences in the operation time and volume of intraoperative blood loss between the two groups (t=5.951, -3.359, P 0.05). There was no significant difference in the cases with postoperative complications between the two groups (P>0.05). (5) Follow-up: all the 42 patients were followed up for 6-16 months, with a median time of 11 months. No serious long-term complications, tumor recurrence and metastasis or death occurred during the follow-up. Conclusions The CUSUM learning curve of Da Vinci robot-assisted radical gastrectomy for gastric cancer can be divided into the learning stage and the mastery stage. It is suggested that the surgeons need to finish 19 cases or more to master Da Vinci robot-assisted radical gastrectomy for gastric cancer. Key words: Gastric neoplasms; Gastric cancer; Cumulative sum analysis; Best fitting curve; Learning curve; Da Vinci robotic surgical system

Robot-assisted distal gastrectomy with lymph node dissection for gastric cancer in a patient with situs inversus partialis: a case report with video file

BackgroundSitus inversus is a rare congenital condition that is currently classified into two types: complete situs inversus (situs inversus totalis, SIT) and partial situs inversus (situs inversus partialis, SIP). In SIP patients, some organs are inverted and others are in their expected position, and individual patient variation in organ position increases surgical difficulty. Several surgeons have performed laparoscopic or robotic surgeries in situs inversus patients, but almost all were SIT patients. We report the first case, to our knowledge, of an SIP patient with gastric cancer who was successfully treated by robot-assisted distal gastrectomy (RADG) with lymph node dissection.Case presentationA 64-year-old woman diagnosed with early gastric cancer on the posterior midbody of the stomach was referred to our hospital for treatment. Computed tomography showed levocardia and inverted abdominal organs without enlarged lymph nodes or distant metastases. Polysplenia syndrome, intestinal malrotation, and left-sided gallbladder were also detected. RADG with D1+ lymph node dissection and Billroth I reconstruction (delta-shaped anastomosis) were performed using robotics. Hepatopathy caused by a liver retractor and pancreatic fistula were identified during the postoperative course, and the latter was classified as grade II based on Clavien-Dindo classification. The patient was discharged 18 days after the operation.ConclusionsPreoperative three-dimensional imaging is beneficial, and anatomical organ identification should be routinely performed, especially in SIP patients. We consider RADG a therapeutic option in SIP patients.

Successful Robotic Gastrectomy Does Not Require Extensive Laparoscopic Experience.

PurposeWe evaluated the learning curve and short-term surgical outcomes of robot-assisted distal gastrectomy (RADG) performed by a single surgeon experienced in open, but not laparoscopic, gastrectomy. We aimed to verify the feasibility of performing RADG without extensive laparoscopic experience.Materials and MethodsBetween July 2012 and December 2016, 60 RADG procedures were performed by a single surgeon using the da Vinci® Surgical System (Intuitive Surgical). Patient characteristics, the length of the learning curve, surgical parameters, and short-term postoperative outcomes were analyzed and compared before and after the learning curve had been overcome.ResultsThe duration of surgery rapidly decreased from the first to the fourth case; after 25 procedures, the duration of surgery was stabilized, suggesting that the learning curve had been overcome. Cases were divided into 2 groups: 25 cases before the learning curve had been overcome (early cases) and 35 later cases. The mean duration of surgery was 420.8 minutes for the initial cases and 281.7 minutes for the later cases (P<0.001). The console time was significantly shorter during the later cases (168.6 minutes) than during the early cases (247.1 minutes) (P<0.001). Although the volume of blood loss during surgery declined over time, there was no significant difference between the early and later cases. No other postoperative outcomes differed between the 2 groups. Pathology reports revealed the presence of mucosal invasion in 58 patients and submucosal invasion in 2 patients.ConclusionsRADG can be performed safely with acceptable surgical outcomes by experts in open gastrectomy.

Impact of an Ultrasonically Activated Device in Robot-Assisted Distal Gastrectomy

Impact of an Ultrasonically Activated Device in Robot-Assisted Distal Gastrectomy

Impact of an Ultrasonically Activated Device in Robot-Assisted Distal Gastrectomy.

Robot-assisted gastrectomy is increasingly used for the treatment of gastric cancer, although it remains a time-consuming procedure. An ultrasonically activated device might be useful to shorten operation times. This study therefore assessed the effect of ultrasonically activated device use on procedural times and on other early surgical outcomes. Consecutive patients (N = 42) who underwent robot-assisted distal gastrectomy for gastric cancer were included. Clinicopathological characteristics and early surgical outcomes were compared between robotic-assisted gastrectomy procedures using an ultrasonically activated device (U group, n = 21) and those without it (NU group, n = 21). There were no significant differences in patient characteristics between the groups; however, the median operation time was significantly less in the U group than in the NU group (291 vs 351 minutes, P = 0.006). In detail, the median duration of console time until dividing the duodenum was less in the U group (70 vs 102 minutes, P < 0.001). Estimated blood loss, incidence of postoperative morbidity, and duration of postoperative hospital stay were not different between the groups. An ultrasonically activated device reduced the operation time of robot-assisted gastrectomy without increasing blood loss and morbidity.

Technique of totally robotic delta-shaped anastomosis in distal gastrectomy.

BACKGROUND:We aimed to clarify the utility of delta-shaped anastomosis (Delta), an intracorporeal Billroth-I anastomosis-based reconstruction technique used after laparoscopy-assisted distal gastrectomy (LADG), in robot-assisted distal gastrectomy (RADG).METHODS:RADG was performed in patients with clinical Stage I gastric cancer, and reconstruction was performed using Delta. The Delta procedure was the same as that performed after LADG, and the operator practiced the procedure in simulated settings with surgical assistants before the operation. After gastrectomy, the scope and robotic first arm were reinserted from separate ports on the right side of the patient. Then, a port on the left side of the abdomen was used as the assistant port from which a stapler was inserted, with the robotic arm in a coaxial mode. The surgical assistant performed functional end-to-end anastomosis of the remnant stomach and duodenal stump using a powered stapler.RESULTS:The mean anastomotic time in four patients who underwent Delta after RADG was 16.5 min. All patients were discharged on the post-operative day 7 without any post-operative complications or need for readmission.CONCLUSIONS:Pre-operative simulation, changes in ports for insertion of the scope and robotic first arm, continuation of the coaxial operation, and use of a powered stapler made Delta applicable for RADG. Delta can be considered as a useful reconstruction method.

Postoperative pancreatic fistula after robot distal gastrectomy

BackgroundTo compare the incidences of postoperative pancreatic fistula (POPF) between robot-assisted distal gastrectomy (RADG) and laparoscopy-assisted distal gastrectomy (LADG). Materials and methodsA total of 40 patients with gastric cancer who underwent RADG were compared with 40 initial patients who underwent LADG by a single surgeon. We evaluated and compared the clinicopathologic characteristics, surgical outcomes, and operative complications including POPF in two groups. ResultsThe POPF was observed more frequently in the LADG group than in the RADG group (22.5% versus 10%, P < 0.001). Although the serum amylase levels in the 20 first-half cases did not statistically differ between LADG and RADG (P = 0.32), those in the 20 latter-half cases were significantly lower in the RADG group (P < 0.05). Univariate and multivariate analyses identified laparoscopic surgery and visceral fat area as POPF-associated risk factors. ConclusionsRADG is feasible and safe for distal gastrectomy in terms of POPF.

Concurrent Robot-Assisted Distal Gastrectomy and Partial Nephrectomy for Synchronous Early Gastric Cancer and Renal Cell Carcinoma: An Initial Experience

Concurrent Robot-Assisted Distal Gastrectomy and Partial Nephrectomy for Synchronous Early Gastric Cancer and Renal Cell Carcinoma: An Initial Experience

Health‐Related Quality of Life After Robot‐Assisted Distal Gastrectomy in Early Gastric Cancer

This study was designed to assess the chronological change in health-related quality of life (HRQOL) following robot-assisted distal gastrectomy (RADG) for early gastric cancer (EGC) and to compare the HRQOL of the patients undergoing RADG with that of the general population. Patients undergoing RADG for EGC between March 2010 and May 2011 were enrolled. The European Organization for Research and Treatment of Cancer (EORTC) core questionnaire (QLQ-C30) and the gastric cancer-specific module (QLQ-STO22) were completed before the operation and at 1 week as well as 1, 3, 6, and 12 months postsurgery. HRQOL data of the enrolled patients were compared to reference values obtained from the general population. A total of 30 patients were enrolled, and the overall compliance for questionnaire response was 94.4 %. The worst scores for most of the domains were observed at 1 week postsurgery and usually returned to baseline levels within 3 months, except for fatigue, dysphagia, pain, and eating restriction. Diarrhea was the only symptom that did not recovered after 1 year. Before surgery, patients reported significantly worse social function and financial difficulties compared to the general population, which persisted for 1 year postsurgery. The immediate deterioration of HRQOL after RADG was restored to baseline levels within 3 months postsurgery in the majority of the patients. Robotic assistance might aid in the rapid recovery of global health status after surgery in EGC patients. Prolonged impairment in social function compared with the general population suggests that psychological support is necessary even for EGC patients.

Robotically-enhanced surgical anatomy enables surgeons to perform distal gastrectomy for gastric cancer using electric cautery devices alone

Despite recent advances in robotic urological surgery, the feasibility and clinical merit of robotic gastric surgery have not yet been fully documented. Therefore, we designed a prospective, non-randomized study to determine the feasibility and safety of robot-assisted distal gastrectomy (RADG) for gastric cancer using electric cautery devices, which are more familiar to open surgery. Between April 2010 and December 2012, 181 patients treated by distal gastrectomy for gastric carcinoma were eligible for this study. According to their intent to undergo uninsured robotic surgery, 21 patients were treated with RADG (RADG group) while 160 patients were treated by conventional laparoscopic distal gastrectomy (LDG group). Under a basic working hypothesis that the superior visualization and unique movement of the robotic arms during dissection would be closely associated with reduced amount of blood loss, even though an equivalent extension of lymph node dissection was carried out, we prospectively collected data from patients in the RADG and LDG groups. All patients were successfully treated without conversion except for one patient in the RADG group who underwent conversion to laparoscopic total gastrectomy. In comparison with the patient groups, the estimated blood loss in patients in the RADG group treated with electric cautery devices only was smaller, but not significantly, than patients in the LDG group treated with ultrasonic-activated devices, although the same extent of lymph node dissection was achieved. In contrast, there were four patients (2.5 %) in the LDG group who developed a pancreas fistula or intra-abdominal abscess, while no patients treated with RADG developed such complications. RADG using electric cautery instruments without ultrasonic-activated devices is feasible and safe. The robot enables particular surgical views, called robotically-enhanced surgical anatomy, and may contribute to reducing blood loss despite the fact that only electric cautery was used.