Robot-assisted laparoscopic total and partial gastric resection with D2 lymph node dissection for adenocarcinoma

Patriti, Alberto; Ceccarelli, Graziano; Bellochi, Raffaele; Bartoli, Alberto; Spaziani, Alessandro; Zitti, L. Di; Casciola, Luciano

doi:10.1007/s00464-008-0129-0

Cited by 104 publications

(124 citation statements)

References 25 publications

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“…To date, in 6 randomized controlled trials, no differences in intra-and postoperative complications, length of hospital stay and symptomatic outcome were detected [5,6,[13][14][15][16] . Operating times were found to be longer than with standard laparoscopic procedures in 5 out of the 6 studies [5,6,[8][9][10] . In addition, robotics significantly increased costs in all the studies evaluating this variable [5,6,13,16] .…”

Section: Discussionmentioning

confidence: 99%

“…From that date, a robotic approach was also proposed to patients with splenic disease, gastric, rectal, pancreatic and liver cancer, prostate and renal cancer and benign and malignant esophageal conditions, resulting in nearly 100 robot-assisted procedures per year. Data were collected prospectively on a computer database and are currently under analysis [8] .…”

Section: Methodsmentioning

confidence: 99%

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Intraoperative and Postoperative Outcome of Robot-Assisted and Traditional Laparoscopic Nissen Fundoplication

Ceccarelli¹,

Patriti²,

Biancafarina³

et al. 2009

Eur Surg Res

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Background: Robotics has been proposed as a tool to improve laparoscopic Nissen fundoplication. However, a clear benefit of this technology for minimally invasive antireflux surgery has not been demonstrated. Materials and Methods: A retrospective review of a prospective database was used to compare the intraoperative and postoperative outcome of 137 patients who underwent conventional laparoscopic fundoplication (CLF) and 45 patients who underwent laparoscopic robot-assisted fundoplication (LRF). Intraoperative outcome measures were: operative time, blood loss and complications. Length of hospital stay, functional results and patient satisfaction were used to compare postoperative outcome. Results: Operative time was significantly shorter in the LRF group (65 min) compared to the CLF group (85 min) (p < 0.0001). The overall complication rate was comparable between the two techniques, even though a higher incidence of liver tears was encountered in the CLF group (p < 0.05). Hospital stay, symptom relief and patient satisfaction did not differ between the groups. Conclusion: Robotics improves surgeon dexterity and maneuverability during laparoscopic Nissen fundoplication, but this does not correspond to a better postoperative outcome. LRF should be used only for complex cases and training.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Intraoperative and Postoperative Outcome of Robot-Assisted and Traditional Laparoscopic Nissen Fundoplication

Ceccarelli¹,

Patriti²,

Biancafarina³

et al. 2009

Eur Surg Res

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“…in 2003. Since then, a few small series have been reported that show relatively good short-term results comparable to those obtained with laparoscopic or conventional open surgery [27][28][29][30][31][32][33][34][35][36][37] . In 2009, Song et al [32] presented their initial 100 cases of robot-assisted gastrectomy with lymph node dissection; it is the largest series for robotic surgery with gastric cancer in the literature.…”

Section: Practicementioning

confidence: 95%

“…Most studies have reported that anastomosis after robotassisted gastrectomy was performed by extracorporeal hand-sewing sutures or intracorporeal stapler [29,31,32] . The mean body mass index of patients is not high for patients in Eastern countries, because of this extracorporeal anastomosis with a small mini-laparotomy of 4 to 5 cm in length is possible.…”

Section: Challenges In the Advanced Fieldmentioning

confidence: 99%

“…Costeffectiveness is also an important matter. Second, there is [29] Gastric adenocarcinoma only Robot 13 -28.1 ± 8.3 3/3/6 Pugliese et al [30] Gastric adenocarcinoma only Robot 9 -27. [32] Gastric adenocarcinoma only Robot 100 58/42 36.7 ± 13.3 (11-83) 74/16/4 Hur et al [33] Gastric adenocarcinoma only Robot 7 ---Pugliese et al [34] Gastric adenocarcinoma only the issue of standardization in the training of surgeons with different laparoscopic experience [16,27,40] .…”

Section: Unresolved Issuesmentioning

confidence: 99%

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Current status of robot-assisted gastric surgery

Baek

Lee²,

Kim³

2011

WJGO

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In an effort to minimize the limitations of laparoscopy, a robotic surgery system was introduced, but its role for gastric cancer is still unclear. The objective of this article is to assess the current status of robotic surgery for gastric cancer and to predict future prospects. Although the current study was limited by its small number of patients and retrospective nature, robot-assisted gastrectomy with lymphadenectomy for the treatment of gastric cancer is a feasible and safe procedure for experienced laparoscopic surgeons. Most studies have reported satisfactory results for postoperative short-term coutcomes, such as: postoperative oral feeding, gas out, hospital stay and complications, compared with laparoscopic surgery; the difference is a longer operation time. However, robotic surgery showed a shallow learning curve compared with the familarity of conventional open surgery; after the accumulation of several cases, robotic surgery could be expected to result in a similar operation time. Robotic-assisted gastrectomy can expand the indications of minimally invasive surgery to include advanced gastric cancer by improving the ability to perform lymphadenectomy. Moreover, "total" robotic gastrectomy can be facilitated using a robotsewing technique and gastric submucosal tumors near the gastroesophageal junction or pylorus can be resected safely by this novel technique. In conclusion, robotassisted gastrectomy may offer a good alternative to conventional open or laparoscopic surgery for gastric cancer, provided that long-term oncologic outcomes can be confirmed.

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Robotic Gastrectomy as an Oncologically Sound Alternative to Laparoscopic Resections for the Treatment of Early-Stage Gastric Cancers

et al. 2011

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827 patients with gastric cancer underwent 236 robotic and 591 laparoscopic radical gastrectomies with curative intent. The patients' data were prospectively collected and retrospectively analyzed. Main Outcome Measures:We performed a comparative analysis between the robotic surgery group and laparoscopic surgery group for preoperative patient characteristics, intraoperative factors, and postoperative morbidity and mortality.Results: The robotic group was younger than the laparoscopic group, but other preoperative patient charac-teristics did not differ. The mean operative time for the robotic group (219.5 minutes) was on average 49 minutes longer than the laparoscopic group (170.7 minutes) (P Ͻ .001), while mean blood loss was significantly less in the robotic group (91.6 mL vs 147.9 mL; P=.002). The robotic group had mortality of 0.4% and morbidity of 11.0%, comparable with those of the laparoscopic group (P Ͼ .05). The number of lymph nodes retrieved per level was adequate in both groups and did not differ significantly. Robotic D1ϩ␣ (n = 5), D1ϩ␤ (n=126), and D2 (n=105) dissections retrieved 27.2, 36.7, and 42.4 mean numbers of lymph nodes, respectively. Except for 3 cases in the laparoscopic group, all specimens had negative margins.Conclusions: Our largest comparative study demonstrates robotic gastrectomy to have better short-term and comparable oncologic outcomes compared with laparoscopic gastrectomy. A robotic approach to gastric cancer is a promising alternative to laparoscopic surgery.

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Robot-assisted laparoscopic total and partial gastric resection with D2 lymph node dissection for adenocarcinoma

Abstract: Robot-assisted laparoscopic lymph node dissection and esophageal anastomosis are feasible and safe. Longer follow-up time and randomized studies are needed to evaluate long-term outcome and clinical advantages of this new technology.

Cited by 104 publications

References 25 publications

Intraoperative and Postoperative Outcome of Robot-Assisted and Traditional Laparoscopic Nissen Fundoplication

Intraoperative and Postoperative Outcome of Robot-Assisted and Traditional Laparoscopic Nissen Fundoplication

Current status of robot-assisted gastric surgery

Robotic Gastrectomy as an Oncologically Sound Alternative to Laparoscopic Resections for the Treatment of Early-Stage Gastric Cancers

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