Review article

Robot-assisted gastric surgery

This study aimed to investigate the short-term surgical and long-term survival outcomes after robotic gastrectomy (RG) or laparoscopic gastrectomy (LG) for patients with Siewert type II and III adenocarcinoma of the esophagogastric junction (AEG).

We retrospectively analyzed 84 and 312 patients with Siewert type II/III AEG who underwent RG or LG between January 2005 and September 2016 in our center. We performed a 1:2 matched propensity score matching (PSM) analysis between the RG and LG group for clinical features to reduce confounding bias. Additionally, the long- and short-term outcomes between the RG and LG group were compared.

The clinicopathological characteristics of 246 patients (RG group: n = 82; LG group: n = 164) were well balanced after PSM. Patients in the RG group showed less estimated blood loss, less time to first flatus, less time to first ambulation, less drainage tube removed time, and retrieved more lymph nodes than the LG group. The overall complication rate was comparable between the RG and LG groups. The 5-year overall survival (OS) was 44.4% in the RG group and 43.7% in the LG group (p = 0.898). The 5-year disease-free survival (DFS) was 43.2% in the RG group and 43.2% in the LG group (p = 0.990). The RG and LG groups exhibited a similar recurrence rate and pattern within 5 years after surgery.

Robotic gastrectomy could be a feasible and safe option for patients with Siewert II/III AEG in terms of surgical and oncologic outcomes.

It is essential to identify variations of celiac artery (CA) and common hepatic artery (CHA), using preoperative computed tomography (CT) imaging, for safe gastrectomy and lymph node dissection in gastric cancer (GC) surgery. We report a relatively rare case with the CHA passing behind the portal vein (PV), in which we performed robot-assisted total gastrectomy (RTG) after chemotherapy as conversion surgery.

A 78-year-old man with GC was referred for conversion surgery. Three-dimensional CT angiography revealed an anomalous CHA passing behind the PV. The anomaly corresponded to type I according to Adachi's classification, and the patient underwent robot-assisted laparoscopic total gastrectomy D2 lymphadenectomy (RTG D2) with Roux-en-Y reconstruction. The operation time was 543 min, blood loss was 115 ml, and no intraoperative complications occurred. The postoperative course was uneventful.

A word of caution during the surgical procedure entails the manipulation of the suprapancreatic lymph node dissection. Initially, it is crucial to identify the anterior surface of the portal vein (PV) and the nerve plexus surrounding the common hepatic artery (CHA). After completely dissecting the entire circumference, the PV is secured using vascular tape. By gently pulling the vascular tape towards the ventral aspect, a safe execution of lymph node dissection no.8 and 12 on the dorsal side of the PV can be accomplished. Meticulous handling of the anatomical abnormalities observed in the preoperative images may prevent unintended hemorrhage.

We report a case with vascular anomalies in which RTG D2 was performed successfully as a conversion surgery.

There is no consensus amongst comparative studies about the advantages of robotic over laparoscopic surgeries for gastric cancer (GC). We compared invasiveness and lymph node dissection between robotic and laparoscopic gastrectomies (RG and LG).

We retrospectively reviewed the medical records of 215 consecutive patients with GC who underwent RG or LG with lymphadenectomy from January 2011–December 2020. Propensity score matching analysis was performed to control selection bias.

The RG group had less operative blood loss (P = 0.0005) and higher C-reactive protein levels on postoperative day 1 (P = 0.0006) than the LG group. When analyzing the specific sites of dissected lymph nodes, station groups of supra-pancreatic and lesser curvature areas accounted for this difference (P = 0.0073 and 0.0362, respectively).

RG demonstrated lesser intraoperative bleeding, less of a postoperative inflammatory response, and a higher proportion of lymph node removal than LG, suggesting that it is a better surgical and oncological procedure.

Robotic surgery has potential benefits in the management of gastric cancer patients. This study compares the outcomes between totally robotic distal gastrectomy (TRDG) with modified port placement and arm positioning technique and conventional totally laparoscopic distal gastrectomy (CTLDG).

Fifty-two patients were enrolled into the study following a retrospective review of an in-patient database between January 2019 and June 2021. Patients who underwent gastric resection with the modified robotic technique were recruited into the study. Patients who did not receive treatment using the modified technique were excluded from the study. Data on demographic, clinical data and surgical outcomes were collected, analyzed, and presented. All statistical analyses were done using IBM SPSS statistical software.

Nineteen patients were in the TRDG group, and their mean age was 60.42 ± 11.53 years. There were no differences in demographic characteristics (all p > 0.05); nonetheless, laparoscopic patients had a significantly higher preoperative albumin level (p = 0.000). The operative time was longer in the TRDG group (223min), but the difference was insignificant. The reconstruction time was significantly shorter for the laparoscopic group (p = 0.000). Except for a significantly higher value of postoperative albumin level (p-value = 0.005) in the robotic group, there were no significant differences in all other surgical outcomes between the two groups. One (5.3%) patient had a severe complication in the robotic group compared to four (12.1%) in the laparoscopic group. Nevertheless, the differences in complications were statistically insignificant.

The modified approach is a safe and feasible in totally robotic distal gastrectomy for the treatment of gastric cancer patients.