Full Robotic sub-total gastrectomy: Our initial experience

Giuseppe Spinoglio, MD, Fabio Priora, MD, Ferruccio Ravazzoni, MD, Luca Matteo Lenti, MD, Raoul Quarati, MD, Valeria Maglione, MD

SS. Antonio e Biagio Hospital of Alessandria (IT). Surgical Department. Unit of Oncologic Surgery

BACKGROUND: We present our initial experience in full robotic subtotal gastrectomy for gastric cancer.

METHODS: Between March 2011 and September 2012, 23 patients ( 14M-9F) , who were diagnosed distal gastric cancer, underwent full-robotic sub total gastrectomy using the da Vinci System Si HD ®. Mean age was 66 years ( 45 – 85), BMI 24 kg/m2 ( 18-32). Our robotic technique was standardized based on Woo Jin Hyung’s layout and steps. Intracorporeal side-to-side gastric-jejunal stapled anastomosis was performed. All patient underwent an upper gastrointestinal series with water-soluble contrast on first postoperative day. Conversion rate, operative time, lymph nodes retrieval, complications, mortality, length of hospital stay and late complication were analyzed.

RESULTS: Full robotic technique was completed successfully in 20 cases. One procedure was converted in open surgery because of the infiltration of the diaphragmatic pillars ( 4.3% conversion). A D1-linphadenectomy was performed in a case of early gastric cancer , a D2-linphadenectomy in all other cases. The mean occupation room time was 400 minutes .The mean console time was 263 minutes. No intraoperative complication was observed. The resection margin was negative in all specimens, and a mean of 29 ( 8-61) lymph nodes was retrieved. All patient started a liquid diet on first postoperative day, a solid diet on second day. Minor complications occurred in two patients and were medically treated ( 8% morbidity). One patients died in X p.o. day for myocardial infarction (4% mortality). Average hospital stay was 7.4 days. No complication occurred in early post-operative follow-up ( 30 days).

CONCLUSIONS: Totally robotic subtotal gastrectomy is a safe and feasible procedure and allows achieving an adequate lymph node harvest and optimal clear margin rates enabling a fast patient recovery, low morbidity and good short-term outcome. Randomized clinical trials and longer follow-up are needed to define advantage and long-term outcome of robotic approach.

Session: Poster Presentation

Program Number: P640