Initial report of near‐infrared fluorescence imaging as an intraoperative adjunct for lymph node harvesting during robot‐assisted laparoscopic gastrectomy

Herrera‐Almario, Gabriel; Patane, Michael; Sarkaria, Inderpal S.; Strong, Vivian E.

doi:10.1002/jso.24226

Cited by 44 publications

(34 citation statements)

References 15 publications

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“…Combined with the robotic visuals in minimally invasive gastric cancer surgery, it has significantly changed the understanding of the pattern of lymphatic drainage, as well as increasing the number of harvested lymph nodes. As proper lymphadenectomy is crucial for an adequate oncological operation for gastric cancer, near infrared imaging improves visualization of vascular anatomy and lymph node identification 47. This technology has been incorporated into multiple specialties as well preventing organ injuries such as to the ureter and biliary ducts 48.…”

Section: New Technologies In Robotic Surgery Systemmentioning

confidence: 99%

Robotic gastrectomy for gastric cancer: Current evidence

Alhossaini

Altamran

Seo

et al. 2017

Annals of Gastroent Surgery

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The robotic system has gained wide acceptance in specialties such as urological and gynecological surgery. It has also been applied in the field of upper gastrointestinal surgery. Since the first implementation of the robotic system for the treatment of gastric adenocarcinoma, the procedure has been found to be safe and feasible. Although robotic gastrectomy does not meet our expectations and yield better results than laparoscopic gastrectomy, this procedure seems to provide several advantages over laparoscopy such as reduced blood loss, shorter learning curves and increased number of retrieved lymph nodes. However, as many case series, including a recent multicenter study, have revealed, higher cost and longer operation time are the major limitations of robotic gastrectomy. Furthermore, there are no results from well‐designed randomized clinical trials comparing the two procedures. New procedures in much more technically demanding cases will test the genuine benefits of robotic gastrectomy.

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Section: New Technologies In Robotic Surgery Systemmentioning

confidence: 99%

Robotic gastrectomy for gastric cancer: Current evidence

Alhossaini

Altamran

Seo

et al. 2017

Annals of Gastroent Surgery

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“…He reported eight successful cases, and this procedure will lead to much better cosmetic results although it should be evaluated in the future with a larger number of patients. Other unique reports include RG with near-infrared fluorescence imaging, and comparison between RG with and without ultrasonic shears (29,34).…”

Section: Single Arm Studiesmentioning

confidence: 99%

Robotic gastrectomy for gastric cancer

Tokunaga

Kaito

Sugita

et al. 2017

Transl. Gastroenterol. Hepatol.

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Correspondence to: Masanori Tokunaga. 6-5-1, Kashiwanoha, Kashiwa, 277-8577 Japan. Email: mtokunag@east.ncc.go.jp.Abstract: The number of robotic gastrectomy (RG) performed per year has been increasing, particularly in East Asia where the incidence of gastric cancer is high and approximately half of the cases are diagnosed as early gastric cancer. With articulated devices of RG, surgeons are able to perform every procedure more meticulously, which can result in less bleeding and damage to organs. There are many single arm and comparative studies, and these study showed similar trends, which included relatively less estimated blood loss and longer operation time following RG than laparoscopic gastrectomy (LG), equivalent number of harvested lymph nodes and similar length of postoperative hospital stay between RG and LG. Considering the results of these retrospective comparative studies, RG seems to be as feasible as LG in terms of early surgical outcomes. However, medical expense of RG is approximately twice as much as that of LG. Lack of solid evidence in terms of long-term outcomes is another problem. Considering the higher medical expenses associated with RG, its superiority in terms of long-term survival outcomes needs to be confirmed in the future for it to be accepted more widely.

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“…Increasingly, robotic stapling technology is utilized to place additional control into the operator's hands during conduit creation and vessel ligation and division. We have also found some advantage to advance near infrared imaging technology, available on robotic platforms, to visualize critical vasculature, assess gastric conduit perfusion, and potentially aid in identification of involved lymph nodes in gastric carcinomas (14,15). The thoracic duct is not routinely ligated, unless injury is suspected.…”

Section: Meticulous Attention To Clear Identification Of Vital Anatomymentioning

confidence: 99%

Robotic assisted minimally invasive esophagectomy for esophageal cancer: a Comment on the Ruijin hospital experience

Pennywell

Sarkaria

2017

J. Thorac. Dis.

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Zhang et al. have described their technical approach to a total laparoscopic and thoracoscopic robotic assisted minimally invasive esophagectomy (RAMIE) via an Ivor Lewis approach for an early stage, distal, esophageal squamous cell carcinoma (1). The authors have offered a nicely detailed written, graphical, and pictorial description of port placement, positioning, and technical execution of the abdominal and thoracic portions of the operation using a three robotic-arm approach for both phases. The thoracic portion of the operation utilizes a semi-prone approach, and the intra-thoracic anastomosis is created using an end to end anastomotic (EEA) stapler. The authors depict several technical aspects including intra-corporeal creation of the gastric conduit, ligation of the thoracic duct, as well as dissection of lymph nodes along both recurrent laryngeal nerves. The patient did well with no immediate post-operative complications, and was discharged on post-operative day 8.The current report is representative of a growing number of institutional series of Ivor Lewis RAMIE for esophageal cancer (2-4). Non-robotic minimally invasive esophagectomy (MIE) has largely been established as an approach with decreased pulmonary and wound complications, and equivalent oncologic outcomes compared to open operations (5,6).While still limited in number, larger series of RAMIE are demonstrating feasibility, safety, and equivalence in early oncologic outcomes compared to other Ivor Lewis approaches (7,8). Putative advantages of the robotic approach include the advanced magnified stereo-optics, stabile and central visualization of the operative field, articulated instrumentation, and ability of the surgeon to self-assist. These advantages can be distilled into a single overarching principle: the surgeon simply gains far more control over the conduct of the operation. Intuitively, this suggests the ability to greatly increase operative efficiency with experienced users of current robotic platforms. These technologies may also potentially allow wider adoption of minimally invasive approaches by surgeons less experienced in standard minimally invasive techniques. However, this hypothesis, often assumed, is yet to be substantiated by evidence based studies.Several cautions and potential pitfalls regarding the RAMIE approach should be considered, especially when instituting new programs. Esophagectomy remains a complex operation, with operative principles and surgeon expertise that remain paramount to gaining acceptable outcomes, regardless of the approach. It is imperative for new programs early in the learning curve for overall RAMIE and/or robotic skill sets to be aware of these challenges, and to avoid recapitulating known and avoidable complications of these operations. First and foremost is the potential for airway injury and subsequent formation of enteric-airway fistula formation. This complication, far more common in minimally invasive operations (RAMIE or MIE), is almost always technical in nature. By and large, these devast...

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Initial report of near‐infrared fluorescence imaging as an intraoperative adjunct for lymph node harvesting during robot‐assisted laparoscopic gastrectomy

Cited by 44 publications

References 15 publications

Robotic gastrectomy for gastric cancer: Current evidence

Robotic gastrectomy for gastric cancer: Current evidence

Robotic gastrectomy for gastric cancer

Robotic assisted minimally invasive esophagectomy for esophageal cancer: a Comment on the Ruijin hospital experience

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