Top

Surgery Today

Published in:

01-10-2019 | Gastrectomy | Original Article

Feasibility of robotic radical gastrectomy using a monopolar device for gastric cancer

Authors: Hiroshi Okabe, Kazutaka Obama, Shigeru Tsunoda, Koichi Matsuo, Eiji Tanaka, Shigeo Hisamori, Yoshiharu Sakai

Published in: Surgery Today | Issue 10/2019

Abstract

Purposes

Laparoscopic gastrectomy using ultrasonic devices occasionally causes postoperative pancreatic fistula. Robotic gastrectomy using monopolar scissors may reduce intraoperative injury to the pancreas. We evaluated the safety and feasibility of robotic gastrectomy.

Methods

A multicenter prospective study was conducted to evaluate the surgical outcomes of robotic gastrectomy. The primary endpoints were the incidence of intraoperative and postoperative complications and operative mortality.

Results

A total of 115 patients were enrolled. The clinical T stages were T1 in 68 patients and T2 or higher in 47 patients. The types of surgery included distal gastrectomy (n = 72), total gastrectomy (n = 39), and proximal gastrectomy (n = 4). Two patients developed intraoperative complications (1.7%), but no cases required conversion to open surgery. The amylase concentration in drainage fluid was higher in cases with pancreatic compression, especially in those with compression for longer than 20 min. Postoperative complications of Clavien–Dindo grade ≥ II occurred in 11 patients (9.6%). There was no mortality. A multivariate analysis indicated that a high body mass index and pancreatic compression by an assistant for longer than 20 min were independent risk factors for postoperative complications (P = 0.029 and P = 0.010).

Conclusions

Robotic gastrectomy using monopolar scissors is safe and feasible. Robotic dissection without compression of the pancreas may reduce postoperative complications.

Available only for authorised users

Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994;4(2):146–8.

Obama K, Okabe H, Hosogi H, Tanaka E, Itami A, Sakai Y. Feasibility of laparoscopic gastrectomy with radical lymph node dissection for gastric cancer: from a viewpoint of pancreas-related complications. Surgery. 2010;149:15–21.CrossRefPubMed

Kim W, Kim HH, Han SU, Kim MC, Hyung WJ, Ryu SW, et al. Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg. 2016;263(1):28–35.CrossRefPubMed

Viñuela EF, Gonen M, Brennan MF, Coit DG, Strong VE. Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg. 2012;255(3):446–56.CrossRefPubMed

Association Japanese Gastric Cancer. Japanese gastric cancer treatment guidelines 2010 (ver.3). Gastric Cancer. 2011;14(2):112–23.

Hiki N, Honda M, Etoh T, Yoshida K, Kodera Y, Kakeji Y, et al. Higher incidence of pancreatic fistula in laparoscopic gastrectomy. Real-world evidence from a nationwide prospective cohort study. Gastric Cancer. 2018;21(1):162–70.CrossRefPubMed

Kobayashi N, Shinohara H, Haruta S, Ohkura Y, Mizuno A, Ueno M, et al. Process of pancreas head as a risk factor for postoperative pancreatic fistula in laparoscopic gastric cancer surgery. World J Surg. 2016;40(9):2194–201.CrossRefPubMed

Irino T, Hiki N, Ohashi M, Nunobe S, Sano T, Yamaguchi T. The hit and away technique: optimal usage of the ultrasonic scalpel in laparoscopic gastrectomy. Surg Endosc. 2015;30:245–50.CrossRefPubMed

Migita K, Matsumoto S, Wakatsuki K, Ito M, Kunishige T, Nakade H, et al. The anatomical location of the pancreas is associated with the incidence of pancreatic fistula after laparoscopic gastrectomy. Surg Endosc. 2016;30(12):5481–9.CrossRefPubMed

10.

Japanese Gastric Cancer Association, Japanese classification of gastric carcinoma: 3rd English edn., Gastric Cancer, vol 14, no 2; 2011. pp. 101–12.

11.

Okabe H, Obama K, Tsunoda S, Tanaka E, Sakai Y. Advantage of completely laparoscopic gastrectomy with linear stapled reconstruction: a long-term follow-up study. Ann Surg. 2014;259(1):109–16.CrossRefPubMed

12.

Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.CrossRefPubMed

13.

Suda K, Man-I M, Ishida Y, Kawamura Y, Satoh S, Uyama I. Potential advantages of robotic radical gastrectomy for gastric adenocarcinoma in comparison with conventional laparoscopic approach: a single institutional retrospective comparative cohort study. Surg Endosc. 2015;29(3):673–85.CrossRefPubMed

14.

Okabe H, Tsunoda S, Obama K, Tanaka E, Hisamori S, Shinohara H, et al. Feasibility of laparoscopic radical gastrectomy for gastric cancer of clinical stage II or higher: early outcomes in a phase II study (KUGC04). Ann Surg Oncol. 2016;23(Suppl 4):516–23.CrossRefPubMed

15.

Tsujiura M, Hiki N, Ohashi M, Nunobe S, Kumagai K, Ida S, et al. “Pancreas-compressionless gastrectomy”: a novel laparoscopic approach for suprapancreatic lymph node dissection. Ann Surg Oncol. 2017;24(11):3331–7.CrossRefPubMed

16.

Hikage M, Tokunaga M, Makuuchi R, Irino T, Tanizawa Y, Bando E, et al. Comparison of surgical outcomes between robotic and laparoscopic distal gastrectomy for cT1 gastric cancer. World J Surg. 2017;42:1803–10.CrossRef

17.

Etoh T, Honda M, Kumamaru H, Miyata H, Yoshida K, Kodera Y, et al. Morbidity and mortality from a propensity score-matched, prospective cohort study of laparoscopic versus open total gastrectomy for gastric cancer: data from a nationwide web-based database. Surg Endosc. 2018;32(6):2766–73.CrossRefPubMed

18.

Sano T, Sasako M, Katai H, Maruyama K. Amylase concentration of drainage fluid after total gastrectomy. Br J Surg. 1997;84(9):1310–2.CrossRefPubMed

19.

Fujita T, Ohta M, Ozaki Y, Takahashi Y, Miyazaki S, Harada T, et al. Collateral thermal damage to the pancreas by ultrasonic instruments during lymph node dissection in laparoscopic gastrectomy. Asian J Endosc Surg. 2015;8(3):281–8.CrossRefPubMed

20.

Kim HI, Han SU, Yang HK, Kim YW, Lee HJ, Ryu KW, et al. Multicenter prospective comparative study of robotic versus laparoscopic gastrectomy for gastric adenocarcinoma. Ann Surg. 2016;263(1):103–9.CrossRef

Title: Feasibility of robotic radical gastrectomy using a monopolar device for gastric cancer
Authors: Hiroshi Okabe
Kazutaka Obama
Shigeru Tsunoda
Koichi Matsuo
Eiji Tanaka
Shigeo Hisamori
Yoshiharu Sakai
Publication date: 01-10-2019
Publisher: Springer Singapore
Keywords: Gastrectomy
Gastric Cancer
Gastric Cancer
Gastrectomy
Published in: Surgery Today / Issue 10/2019
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-019-01802-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Feasibility of robotic radical gastrectomy using a monopolar device for gastric cancer

Abstract

Purposes

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purposes

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2019

Etiology and management of low anterior resection syndrome based on the normal defecation mechanism

Ambiguity about the volume of colloids administered in a clinical study of thoracic esophagectomy precludes conclusions on the renal safety of hydroxyethyl starch

Antimicrobial prophylaxis for 1 day versus 3 days in liver cancer surgery: a randomized controlled non-inferiority trial

Score of the preoperative absolute number of lymphocytes, monocytes, and neutrophils as a prognostic indicator for patients with gastric cancer

A snapshot of surgical resident training in Japan: results of a national-level needs assessment survey

Reply to comment on “Ambiguity about the volume of colloids administration in a clinical study of thoracic esophagectomy precludes conclusion on renal safety of hydroxyethyl starch”