Robotic Subtotal Gastrectomy Research Articles

A025 Robotic Sub-total Gastrectomy for Refractory Marginal Ulcers after Gastric Bypass

A025 Robotic Sub-total Gastrectomy for Refractory Marginal Ulcers after Gastric Bypass

Robotic Subtotal Gastrectomy with Small Remnant Stomach for Gastric Cancer in the Upper Stomach

BackgroundRobotic subtotal gastrectomy (RsTG) with a small remnant stomach for treatment of gastric cancer (GC) in the upper stomach may have advantages over robotic TG (RTG). These may affect postoperative complications and postoperative nutritional status. MethodsThis is a single-center retrospective study of 46 consecutive patients with GC who underwent RsTG (n = 10) and RTG (n = 36). The indication for RsTG included tumor located in the upper body of the stomach, in which the distance between the upper edge of the tumor and the junction was 2 cm or more and less than 5 cm, and no clinical evidence of lymph node metastasis. ResultsOperation time was significantly longer (384 min) and intraoperative blood loss was significantly larger (38 ml) in the RTG group than in the RsTG group (299.5 min, P = 0.021, and 25 ml P = 0.002). Two patients (5.6%) in the RTG group had complications, while no postoperative complications of higher than grade II were observed in the RsTG group. Serum albumin levels at 3 months after surgery were significantly higher in the RsTG group (3.85 g/dl) than in the RTG group (3.2 g/dl, P = 0.001). Postoperative recovery of bodyweight at 6 months after surgery was significantly better in the RsTG group (91.3%) than in the RTG group (84.25%, P = 0.001). ConclusionRsTG for treatment of patients with GC in the upper body of the stomach is safe and feasible, and may enable improved postoperative nutritional status compared with RTG.

Gastrectomy for gastroparesis: when and how

: Gastroparesis is a chronic and debilitating gastric motility disorder characterized by delayed gastric emptying in the absence of mechanical obstruction. The disease is frequently refractory to medical therapies, and multiple surgical options exist to treat medically refractory gastroparesis. However, a formal management algorithm has yet to be agreed upon. Furthermore, the best utilization and approach for the most extreme surgical option, gastrectomy, continues to be debated. This review article presents our surgical treatment algorithm and provides an overview of the literature surrounding various surgical options currently used in practice including gastric electrical stimulation, pyloroplasty, per-oral pyloromyotomy (POP), enteral feeding tubes, and sleeve gastrectomy. We additionally take a deeper look at the end of the line surgical therapy, gastrectomy, in an attempt to answer the question of when and how this definitive surgery should be utilized. While a gastrectomy is an extreme surgical treatment modality, for patients who fail less invasive surgical measures, gastrectomy often has favorable results in controlling symptoms and improving patients’ quality of life with an acceptable morbidity rate. However, gastrectomy should only be considered after exhausting all organ-sparing options. While there is no “one size fits all” surgical treatment modality for refractory gastroparesis, our recommendation for a definitive operation for medically refractory gastroparesis is a laparoscopic or robotic subtotal gastrectomy with a Roux-en-Y gastrojejunostomy reconstruction.

ICG‐NIR‐guided lymph node dissection during robotic subtotal gastrectomy for gastric cancer. A single‐centre experience

Near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) allows intraoperative visualisation of the lymph nodes (LNs) draining the tumour. We included in our study 20 patients who underwent robotic subtotal gastrectomy+D2 lymphadenectomy for gastric cancer. In 10 cases, intraoperative ICG-guided lymphography has been used (Group A). We compared the number of LNs retrieved with the use of NIR imaging and the number of LNs retrieved without the use of this technique (Group B, historical group). No complications related to ICG injection or near-infrared imaging were observed. The mean number of overall LNs retrieved was significantly greater in Group A than in group B (40 vs. 24). No statistically significant difference in operative time was observed. ICG-guided fluorescent lymphography can help in performing a more accurate locoregional lymphadenectomy during robotic subtotal gastrectomy for gastric cancer. This technique represents a precious contribution to gastric cancer surgery.

Fluorescent-Image Guidance in Robotic Subtotal Gastrectomy.

Robotic surgery technology has significant advantages, but its limitations include lack of tactile feedback. Fluorescent-imaging technology, part of the da Vinci robotic surgery system, helps to overcome this lack of feedback and improve safety. This video demonstrates the utility of fluorescent-image guidance in robotic subtotal gastrectomy. First, peritumoral injection of indocyanine green helps localize the primary lesion. Second, it enables visualization of sentinel lymphatic flow to guide the extent of lymph node dissection. Third, intravenous injection of indocyanine green confirms adequate tissue perfusion of the remnant stomach. Lastly, fluorescent angiography also visualizes the jejunal arterial arcade in the mesentery. In summary, we consider that fluorescent-image guidance may provide important intraoperative information that supports techniques of robotic subtotal gastrectomy. Further studies to validate the benefits of fluorescent-image guidance are needed.

Full Robotic Subtotal Gastrectomy with Extended (D2) Lymphadenectomy

Abstract Introduction: Widespread diffusion of minimally invasive surgery for gastric cancer treatment is limited by the complexity of performing an extended D2-lymphadenectomy.1–4 This surgical st...