Can Robotic Gastrectomy Surpass Laparoscopic Gastrectomy by Acquiring Long-Term Experience? A Propensity Score Analysis of a 7-Year Experience at a Single Institution

Abstract

Purpose: It is hypothesized that robotic gastrectomy may surpass laparoscopic gastrectomy after the operators acquire long-term experience and skills in the manipulation of robotic arms. This study aimed to evaluate the long-term learning curve of robotic distal gastrectomy (RDG) for gastric cancer compared with laparoscopic distal gastrectomy (LDG). Materials and Methods: From October 2008 to December 2015, patients who underwent LDG (n=809) were matched to patients who underwent RDG (n=232) at a 1:1 ratio, by using a propensity score matching method after stratification for the operative year. The surgical outcomes, such as trends of operative time, blood loss, and complication rate, were compared between the two groups. Results: The RDG group showed a longer operative time (171.3 minutes vs. 147.6 minutes, P<0.001) but less estimated blood loss (77.6 ml vs. 116.6 ml, P<0.001). The complication rate and postoperative recovery did not differ between the two groups. The RDG group showed a longer operative time and similar estimated blood loss compared with the LDG group after 5 years of experience (operative time: 159.2 minutes vs. 136.0 minutes in 2015, P=0.003; estimated blood loss: 72.9 ml vs. 78.1 ml in 2015, P=0.793). Conclusions: In terms of short-term surgical outcomes, RDG may not surpass LDG after a long-term experience with the technique.

Robotic Versus Laparoscopic Gastrectomy for Gastric Cancer: A Systematic Review and Meta-Analysis

“…A total of 430 potential articles,which were published before May 2020,were retrieved from our databases.After removing 66 duplicates,246 studies excluded by carefully reading the titles and abstracts because it was a review,letter,conference report,comment,case report or animal experimental study.118 potential articles were thoroughly evaluated through full text articles,and nally,a total of 19 retrospective studies were included in the nal meta-analysis according to inclusion and exclusion criteria [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38].A ow diagram of the search strategies,which includes reasons for the exclusion of studies, is shown in Fig. 1.…”

Robotic Surgery, Is It the Future?

“…Whilst laparoscopic distal gastrectomy was comparable to open distal gastrectomy in terms of short and long-term outcomes and is now considered a safe and technically feasible treatment option for early-stage gastric cancer, robotic gastric surgery did not show any tangible advantages over laparoscopic distal gastrectomy in terms of blood loss, complications or short term outcome [6]. Nevertheless, compared with open surgery, laparoscopy exhibits comparable or poorer retrieval of lymph nodes whilst robotic surgery shows comparable or better retrieval of lymph nodes than laparoscopy which means that robotic surgery may be able to address this significant weakness of traditional laparoscopy [4].…”

“…The essential advantages of robots are the high definition, threedimensional (3D) stable camera which provides a much more magnified view than the laparoscopic camera as the robotic surgeon sits in a console (two consoles if the operation is performed by two surgeons) and controls effector robotic arms (usually three or four arms) which have greater maneuverability than the human wrist thus providing better angles for the operator, keeping in mind that the assistant, who stands at the operation table, uses a laparoscopic rather than a robotic screen [1,3,5]. The comfortable position of the surgeon is expected to minimize the adverse effects of fatigue allowing surgeons to perform more operations per day without decrease in performance [3,6]. The ability of the robot to filter the physiological human tremors gives it an advantage over the conventional laparoscopic surgery [5].…”

“…The main disadvantages of robots are the higher costs, increased surgical time and the total loss of tactile sensation [5,6]. Two points have to be considered in relation to these disadvantages: 1.…”

“…A part of the increased surgical time is spent in docking the robot 2. The loss of tactile sensation is much more than in conventional laparoscopy where the surgeon still keeps some sensation which, in turn, has always been regarded as a disadvantage of laparoscopy compared to open surgery [5,6,9]. Whilst it is conceptually mechanically easier to perform robotic hand knots, being three dimensional, compared to laparoscopic surgery, the total lack of tactile sensation somewhat negates this advantage as the tension on the knot relies only on the surgeon's vision [5] which might make it practically less secure and more difficult.…”