Wanda Petz, MD, Emilio Bertani, MD, Simona Borin, MD, Alessandra Piccioli, MD, Uberto Fumagalli Romario, MD,Giuseppe Spinoglio, MD, FACS. European Institute of Oncology
Background: Robotic gastrectomy is a feasible alternative to laparoscopic gastrectomy, providing similar short-term clinical benefits over open gastrectomy for cancer.
Robotic surgery, conceived to overcome technical limitations intrinsic to the laparoscopic approach, may be of particular interest in complex surgical procedures as gastrectomy with D2 lymphadenectomy.
We present a preliminary experience of robotic distal gastrectomy with the use of Indocyanine Green (ICG) fluorescence to visualize the lymphatic draining area and to assess stumps perfusion before anastomosis.
Methods: The day before surgery, in patients scheduled for robotic distal gastrectomy a gastroscopy is performed and an injection of 2.5 mg of ICG sis realized adjacent to the tumor in the submucosa.
Robotic distal gastrectomy is performed with the Da Vinci Xi System inserting four robotic trocars along a transverse umbilical line
Site of primary tumor and lymphatic draining basin are visualized with the Firefly camera modality, thus guiding D2 lymphadenectomy, which is systematically performed.
After intravenous ICG injection (0.05 mg/kg of ICG solution at a dilution of 2.5 mg/ml), perfusion of gastric and jejunal stump is assessed, and an intracorporeal gastro-jejunostomy with robotic linear stapler and manual closure of inserting holes is performed.
The specimen is extracted through a Pfannenstiel incision.
Results: From July 2016 to August 2018, 14 patients (8 males, 6 females; median age 70 years, median BMI 24 kg/m2) with antral adenocarcinoma received a robotic distal gastrectomy with D2 lymphadenectomy.
Preoperative staging identified three nodal-positive patients, who received neoadjuvant chemotherapy, according to Institutional policy.
No intraoperative complications nor conversions to open surgery occurred; ICG fluorescence allowed the visualization of the site of primary tumor, of lymphatic draining basin and of gastric and jejunal stumps perfusion before anastomosis in all patients.
Median number of harvested lymph nodes was 37 (range 19-53); median time to first bowel movements 3 days (2-5), median time to soft oral diet 4 days (3-7), median hospital stay 7 days (5-18).
Anastomotic or duodenal stump leak did not occurr in any patient, while two patients (14%) required a percutaneous drainage of peripancreatic and hematic pelvic fluid collection.
Conclusions: In this preliminary experience, robotic distal gastrectomy confirmed to be feasible and safe, providing good clinical results.
Moreover, the use of ICG fluorescence allowed to safely perform an extended lymphadenectomy, and the intraoperative assessment of good perfusion of gastric and jejunal stumps before anastomosis led to the absence of anastomotic complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95401
Program Number: P497
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster