Norihiro Shimoike1, Tatsuto Nishigori2, Yoshito Yamashita3, Masato Kondo4, Dai Manaka5, Yoshio Kadokawa6, Atsushi Itami7, Seiichiro Kanaya8, Hisahiro Hosogi8, Seiji Satoh9, Hiroaki Hata10, Takatsugu Kan11, Hironori Kawada12, Michihiro Yamamoto13, Eiji Tanaka11,14, Shigeru Tsunoda1, Shigeo Hisamori1, Koya Hida1, Kentaro Ueno15, Shiro Tanaka16, Kazutaka Obama1. 1. Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-choSakyo-ku, ShogoinKyoto, 606-8507, Japan. 2. Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-choSakyo-ku, ShogoinKyoto, 606-8507, Japan. nsgr@kuhp.kyoto-u.ac.jp. 3. Department of Gastroenterological Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan. 4. Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan. 5. Department of Surgery, Kyoto Katsura Hospital, Kyoto, Japan. 6. Department of Gastrointestinal Surgery, Tenri Hospital, Tenri, Japan. 7. Department of Surgery, Kobe City Nishi-Kobe Medical Center, Kobe, Japan. 8. Department of Surgery, Osaka Red Cross Hospital, Osaka, Japan. 9. Department of Surgery, Kyoto City Hospital, Kyoto, Japan. 10. Department of Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. 11. Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Japan. 12. Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan. 13. Department of Surgery, Shiga General Hospital, Moriyama, Japan. 14. Department of Surgery, Kitano Hospital, Osaka, Japan. 15. Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 16. Department of Clinical Biostatistics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Abstract
BACKGROUND: The safety of robotic gastrectomy (RG) for gastric cancer in daily clinical settings and the process by which surgeons are introduced and taught RG remain unclear. This study aimed to evaluate the safety of RG in daily clinical practice and assess the learning process in surgeons introduced to RG. METHODS: Patients who underwent RG for gastric cancer at Kyoto University and 12 affiliated hospitals across Japan from January 2017 to October 2019 were included. Any morbidity with a Clavien-Dindo classification grade of II or higher was evaluated. Moreover, the influence of the surgeon's accumulated RG experience on surgical outcomes and surgeon-reported postoperative fatigue were assessed. RESULTS: A total of 336 patients were included in this study. No conversion to open or laparoscopic surgery and no in-hospital mortality were observed. Overall, 50 (14.9%) patients developed morbidity. During the study period, 14 surgeons were introduced to robotic procedures. The initial five cases had surprisingly lower incidence of morbidity compared to the following cases (odds ratio 0.29), although their operative time was longer (+ 74.2 min) and surgeon's fatigue scores were higher (+ 18.4 out of 100 in visual analog scale). CONCLUSIONS: RG was safely performed in actual clinical settings. Although the initial case series had longer operative time and promoted greater levels of surgeon fatigue compared to subsequent cases, our results suggested that RG had been introduced safely.
BACKGROUND: The safety of robotic gastrectomy (RG) for gastric cancer in daily clinical settings and the process by which surgeons are introduced and taught RG remain unclear. This study aimed to evaluate the safety of RG in daily clinical practice and assess the learning process in surgeons introduced to RG. METHODS: Patients who underwent RG for gastric cancer at Kyoto University and 12 affiliated hospitals across Japan from January 2017 to October 2019 were included. Any morbidity with a Clavien-Dindo classification grade of II or higher was evaluated. Moreover, the influence of the surgeon's accumulated RG experience on surgical outcomes and surgeon-reported postoperative fatigue were assessed. RESULTS: A total of 336 patients were included in this study. No conversion to open or laparoscopic surgery and no in-hospital mortality were observed. Overall, 50 (14.9%) patients developed morbidity. During the study period, 14 surgeons were introduced to robotic procedures. The initial five cases had surprisingly lower incidence of morbidity compared to the following cases (odds ratio 0.29), although their operative time was longer (+ 74.2 min) and surgeon's fatigue scores were higher (+ 18.4 out of 100 in visual analog scale). CONCLUSIONS: RG was safely performed in actual clinical settings. Although the initial case series had longer operative time and promoted greater levels of surgeon fatigue compared to subsequent cases, our results suggested that RG had been introduced safely.
Authors: Young Kyu Park; Hong Man Yoon; Young-Woo Kim; Ji Yeon Park; Keun Won Ryu; Young-Joon Lee; Oh Jeong; Ki Young Yoon; Jun Ho Lee; Sang Eok Lee; Wansik Yu; Sang-Ho Jeong; Taebong Kim; Sohee Kim; Byoung-Ho Nam Journal: Ann Surg Date: 2018-04 Impact factor: 12.969
Authors: Hyuk-Joon Lee; Woo Jin Hyung; Han-Kwang Yang; Sang Uk Han; Young-Kyu Park; Ji Yeong An; Wook Kim; Hyoung-Il Kim; Hyung-Ho Kim; Seung Wan Ryu; Hoon Hur; Seong-Ho Kong; Gyu Seok Cho; Jin-Jo Kim; Do Joong Park; Keun Won Ryu; Young Woo Kim; Jong Won Kim; Joo-Ho Lee; Min-Chan Kim Journal: Ann Surg Date: 2019-12 Impact factor: 12.969