Hiroshi Okabe1,2,3, Kazutaka Obama4,5, Shigeru Tsunoda4, Koichi Matsuo5, Eiji Tanaka4,6, Shigeo Hisamori4, Yoshiharu Sakai4. 1. Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. hokabe@kuhp.kyoto-u.ac.jp. 2. Department of Gastroenterological Surgery, New Tokyo Hospital, Matsudo, Japan. hokabe@kuhp.kyoto-u.ac.jp. 3. Department of Surgery, Otsu City Hospital, Otsu, Japan. hokabe@kuhp.kyoto-u.ac.jp. 4. Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 5. Department of Surgery, Kyoto City Hospital, Kyoto, Japan. 6. Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Japan.
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.
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.
Entities:
Keywords:
Gastrectomy; Gastric cancer; Laparoscopic surgery; Pancreatic fistula; Robotic surgery