Successful Robotic Gastrectomy Does Not Require Extensive Laparoscopic Experience

Abstract

PurposeWe evaluated the learning curve and short-term surgical outcomes of robot-assisted distal gastrectomy (RADG) performed by a single surgeon experienced in open, but not laparoscopic, gastrectomy. We aimed to verify the feasibility of performing RADG without extensive laparoscopic experience.Materials and MethodsBetween July 2012 and December 2016, 60 RADG procedures were performed by a single surgeon using the da Vinci® Surgical System (Intuitive Surgical). Patient characteristics, the length of the learning curve, surgical parameters, and short-term postoperative outcomes were analyzed and compared before and after the learning curve had been overcome.ResultsThe duration of surgery rapidly decreased from the first to the fourth case; after 25 procedures, the duration of surgery was stabilized, suggesting that the learning curve had been overcome. Cases were divided into 2 groups: 25 cases before the learning curve had been overcome (early cases) and 35 later cases. The mean duration of surgery was 420.8 minutes for the initial cases and 281.7 minutes for the later cases (P<0.001). The console time was significantly shorter during the later cases (168.6 minutes) than during the early cases (247.1 minutes) (P<0.001). Although the volume of blood loss during surgery declined over time, there was no significant difference between the early and later cases. No other postoperative outcomes differed between the 2 groups. Pathology reports revealed the presence of mucosal invasion in 58 patients and submucosal invasion in 2 patients.ConclusionsRADG can be performed safely with acceptable surgical outcomes by experts in open gastrectomy.

Robotic Versus Laparoscopic Gastrectomy for Gastric Adenocarcinoma: Propensity-Matched Analysis

“…Also, the learning curve may be better for adoption by surgeons who may not be facile in laparoscopic surgery. [7][8][9] However, the data comparing robotic surgery to laparoscopic surgery are limited to small numbers and mostly retrospective in nature. 6,10,11 Furthermore, most of the studies comparing the 2 approaches are from East Asia or from high-volume centers.…”

Robot-assisted laparoscopic subtotal gastrectomy for early-stage gastric cancer: Case series of initial experience

“…In literature [ 18 , 55 , 56 ], it was demonstrated that robotic surgery requires a shorter learning curve as compared to conventional laparoscopy and that surgeons without extensive experience in laparoscopic gastrectomy can safety perform RADG with acceptable surgical outcomes. An [ 57 ] affirmed that surgeons with experience in open gastrectomy can easily achieve the stabilization of the duration of RADG after 25 cases. According to these findings, performing robotic total gastrectomy with handsewn intracorporeal anastomosis after an adequate learning curve with RADG represents a good option for patients.…”

Feasibility of Linear-Shaped Gastroduodenostomy during the Performance of Totally Robotic Distal Gastrectomy

“…Robotic surgery can be performed safely with acceptable surgical outcomes by experts in open gastrectomy, with the learning curve for robotic gastrectomy being significantly overcome by a sufficient experience with laparoscopic gastrectomy [272829]. The shorter hospitalization time observed in patients who underwent TRDG may be due to the performance of a surgeon with extensive laparoscopic experience, including stable and proficient dissection techniques.…”