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Comparison of Surgical Outcomes between Robotic and Laparoscopic Gastrectomy for Gastric Cancer: The Learning Curve of Robotic Surgery.

Kang BH, Xuan Y, Hur H, Ahn CW, Cho YK, Han SU - J Gastric Cancer (2012)

Bottom Line: The robotic gastrectomy patients were divided into 20 initial cases; and all subsequent cases; and we compared the clinicopathological features, operating times, and surgical outcomes between the three groups.The initial group had a longer average operating time (242.25±74.54 minutes vs. 192.56±39.56 minutes, P>0.001), and hospital stay (14.40±24.93 days vs. 8.66±5.39 days, P=0.001) than the experienced group.Our study shows that robotic gastrectomy is a safe and feasible procedure, especially after the 20 initial cases, and provides a satisfactory postoperative outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Ajou University School of Medicine, Suwon, Korea.

ABSTRACT

Purpose: Laparoscopic gastrectomy is a widely accepted surgical technique. Recently, robotic gastrectomy has been developed, as an alternative minimally invasive surgical technique. This study aimed to evaluate the question of whether robotic gastrectomy is feasible and safe for the treatment of gastric cancer, due to its learning curve.

Materials and methods: We retrospectively reviewed the prospectively collected data of 100 consecutive robotic gastrectomy patients, from November 2008 to March 2011, and compared them to 282 conventional laparoscopy patients during the same period. The robotic gastrectomy patients were divided into 20 initial cases; and all subsequent cases; and we compared the clinicopathological features, operating times, and surgical outcomes between the three groups.

Results: The initial 20 robotic gastrectomy cases were defined as the initial group, due to the learning curve. The initial group had a longer average operating time (242.25±74.54 minutes vs. 192.56±39.56 minutes, P>0.001), and hospital stay (14.40±24.93 days vs. 8.66±5.39 days, P=0.001) than the experienced group. The length of hospital stay was no different between the experienced group, and the laproscopic gastrectomy group (8.66±5.39 days vs. 8.11±4.10 days, P=0.001). The average blood loss was significantly less for the robotic gastrectomy groups, than for the laparoscopic gastrectomy group (93.25±84.59 ml vs. 173.45±145.19 ml, P<0.001), but the complication rates were no different.

Conclusions: Our study shows that robotic gastrectomy is a safe and feasible procedure, especially after the 20 initial cases, and provides a satisfactory postoperative outcome.

No MeSH data available.


Related in: MedlinePlus

Trocar insertion in a robotic gastrectomy case (right) and laparoscopic case (left). The robotic case had lower trocar sites than the laparoscopic case.
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Figure 1: Trocar insertion in a robotic gastrectomy case (right) and laparoscopic case (left). The robotic case had lower trocar sites than the laparoscopic case.

Mentions: Both operation types used a total of five trocars. The first trocar was inserted in the infraumbilical area (a 10 mm trocar in LG and a 12 mm trocar in RG) using the closed method and made pneumoperitoneum and intracoporeal pressure was increased up to 12 mmHg by CO2 gas. The scope (a single-lens in LG and a dual-lens in RG) was inserted through this trocar. An additional four trocars were placed under direct visualization. In LG, two 5-mm trocars were placed on the left side, and one 5-mm trocar was placed on the upper right side. A 12-mm trocar was placed on the right central side. In RG, two 8-mm trocars were placed on the right side, and one 8-mm trocar was placed on the outer left side. A 12-mm trocar was placed on the central left side (Fig. 1). In LG, the operator works on the patient's right side and uses the right side trocars. Two assistants stand on the left side and use the left side trocars or scope. In RG, Cadiere forceps (Intuitive Surgical Inc., Sunnyvale, CA, USA) were introduced through the right upper 8-mm trocar, and a Harmonic scalpel (Ethicon EndoSurgery Inc., Cincinnati, OH, USA) was introduced through the right central 8-mm trocar. Maryland bipolar forceps (Intuitive Surgical Inc.) were inserted through the left outer 8-mm trocar, and the remaining left central trocar was used by the assistant. Initially, the liver was retracted using a V-shaped method (before the robot was docked in the robot case),(18) and the greater omentum was resected using the Harmonic scalpel in both operation types. After the division and ligation of the left gastroepiploic vessels at the root, dissection around the lymph nodes was performed toward the pylorus. The right gastroepiploic vessels were divided and ligated at the root. After the lesser omentum of the upper duodenum was resected, the right gastric vessels were identified from the hepatic artery and ligated at the root. Then, the duodenum was transected 1~2 cm distal to the pyloric ring using a laparoscopic stapling device. In LG, the operator transected the duodenum, but the assistant performed this procedure in RG. The lymph nodes were dissected until the root of the liver hilum, common hepatic artery and splenic artery were exposed. After the division and ligation of the left gastric vessels at the root, dissection around the lymph nodes was performed. In the total gastrectomy cases, the lymph nodes around the splenic artery or splenic hilum were harvested, and the short gastric artery was ligated. After the vagus nerve was ligated, the esophagus was transected. Resection and anastomosis were similar for LG and RG. In subtotal gastrectomy cases, after the lymph nodes along the lesser curvature were removed, the stomach was transected using a laparoscopic surgical stapling device. In extracorporeal anastomosis, an incision of approximately 5 cm was made at the upper abdomen for a mini-laparotomy. In intracoporeal anastomosis, gastroduodenostomy (linear stapler technique) or gastrojejunostomy or esophagojejunostomy was performed using a laparoscopic stapler device and reinforced by a suture or completely robot-sewn anastomosis, as reported previously.(19,20)


Comparison of Surgical Outcomes between Robotic and Laparoscopic Gastrectomy for Gastric Cancer: The Learning Curve of Robotic Surgery.

Kang BH, Xuan Y, Hur H, Ahn CW, Cho YK, Han SU - J Gastric Cancer (2012)

Trocar insertion in a robotic gastrectomy case (right) and laparoscopic case (left). The robotic case had lower trocar sites than the laparoscopic case.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3473222&req=5

Figure 1: Trocar insertion in a robotic gastrectomy case (right) and laparoscopic case (left). The robotic case had lower trocar sites than the laparoscopic case.
Mentions: Both operation types used a total of five trocars. The first trocar was inserted in the infraumbilical area (a 10 mm trocar in LG and a 12 mm trocar in RG) using the closed method and made pneumoperitoneum and intracoporeal pressure was increased up to 12 mmHg by CO2 gas. The scope (a single-lens in LG and a dual-lens in RG) was inserted through this trocar. An additional four trocars were placed under direct visualization. In LG, two 5-mm trocars were placed on the left side, and one 5-mm trocar was placed on the upper right side. A 12-mm trocar was placed on the right central side. In RG, two 8-mm trocars were placed on the right side, and one 8-mm trocar was placed on the outer left side. A 12-mm trocar was placed on the central left side (Fig. 1). In LG, the operator works on the patient's right side and uses the right side trocars. Two assistants stand on the left side and use the left side trocars or scope. In RG, Cadiere forceps (Intuitive Surgical Inc., Sunnyvale, CA, USA) were introduced through the right upper 8-mm trocar, and a Harmonic scalpel (Ethicon EndoSurgery Inc., Cincinnati, OH, USA) was introduced through the right central 8-mm trocar. Maryland bipolar forceps (Intuitive Surgical Inc.) were inserted through the left outer 8-mm trocar, and the remaining left central trocar was used by the assistant. Initially, the liver was retracted using a V-shaped method (before the robot was docked in the robot case),(18) and the greater omentum was resected using the Harmonic scalpel in both operation types. After the division and ligation of the left gastroepiploic vessels at the root, dissection around the lymph nodes was performed toward the pylorus. The right gastroepiploic vessels were divided and ligated at the root. After the lesser omentum of the upper duodenum was resected, the right gastric vessels were identified from the hepatic artery and ligated at the root. Then, the duodenum was transected 1~2 cm distal to the pyloric ring using a laparoscopic stapling device. In LG, the operator transected the duodenum, but the assistant performed this procedure in RG. The lymph nodes were dissected until the root of the liver hilum, common hepatic artery and splenic artery were exposed. After the division and ligation of the left gastric vessels at the root, dissection around the lymph nodes was performed. In the total gastrectomy cases, the lymph nodes around the splenic artery or splenic hilum were harvested, and the short gastric artery was ligated. After the vagus nerve was ligated, the esophagus was transected. Resection and anastomosis were similar for LG and RG. In subtotal gastrectomy cases, after the lymph nodes along the lesser curvature were removed, the stomach was transected using a laparoscopic surgical stapling device. In extracorporeal anastomosis, an incision of approximately 5 cm was made at the upper abdomen for a mini-laparotomy. In intracoporeal anastomosis, gastroduodenostomy (linear stapler technique) or gastrojejunostomy or esophagojejunostomy was performed using a laparoscopic stapler device and reinforced by a suture or completely robot-sewn anastomosis, as reported previously.(19,20)

Bottom Line: The robotic gastrectomy patients were divided into 20 initial cases; and all subsequent cases; and we compared the clinicopathological features, operating times, and surgical outcomes between the three groups.The initial group had a longer average operating time (242.25±74.54 minutes vs. 192.56±39.56 minutes, P>0.001), and hospital stay (14.40±24.93 days vs. 8.66±5.39 days, P=0.001) than the experienced group.Our study shows that robotic gastrectomy is a safe and feasible procedure, especially after the 20 initial cases, and provides a satisfactory postoperative outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Ajou University School of Medicine, Suwon, Korea.

ABSTRACT

Purpose: Laparoscopic gastrectomy is a widely accepted surgical technique. Recently, robotic gastrectomy has been developed, as an alternative minimally invasive surgical technique. This study aimed to evaluate the question of whether robotic gastrectomy is feasible and safe for the treatment of gastric cancer, due to its learning curve.

Materials and methods: We retrospectively reviewed the prospectively collected data of 100 consecutive robotic gastrectomy patients, from November 2008 to March 2011, and compared them to 282 conventional laparoscopy patients during the same period. The robotic gastrectomy patients were divided into 20 initial cases; and all subsequent cases; and we compared the clinicopathological features, operating times, and surgical outcomes between the three groups.

Results: The initial 20 robotic gastrectomy cases were defined as the initial group, due to the learning curve. The initial group had a longer average operating time (242.25±74.54 minutes vs. 192.56±39.56 minutes, P>0.001), and hospital stay (14.40±24.93 days vs. 8.66±5.39 days, P=0.001) than the experienced group. The length of hospital stay was no different between the experienced group, and the laproscopic gastrectomy group (8.66±5.39 days vs. 8.11±4.10 days, P=0.001). The average blood loss was significantly less for the robotic gastrectomy groups, than for the laparoscopic gastrectomy group (93.25±84.59 ml vs. 173.45±145.19 ml, P<0.001), but the complication rates were no different.

Conclusions: Our study shows that robotic gastrectomy is a safe and feasible procedure, especially after the 20 initial cases, and provides a satisfactory postoperative outcome.

No MeSH data available.


Related in: MedlinePlus