Robotic Gastric Cancer Surgery using da Vinci system: Clinical results & lessons learned from 2-year experience.

Background: For gastric cancer, robotic surgery is still in its early years. This study is performed to evaluate the technical feasibility, effect, and safety of robot-assisted gastrectomy (RAG) with lymphadenectomy using da Vinci system
Methods: From July 2005 to April 2007, 80 RAG with lymphadenectomy were performed for patients with preoperative diagnosis of EGC. The clinicopathologic features and surgical outcomes were analyzed.
Results: There were 40 males and 40 females with a mean age of 53 years (range=20~89 years). None of the patients needed open conversion. D1+beta or more extended lymphadenectomy was performed. Distal subtotal gastrectomy was performed for 55 patients and total gastrectomy was performed for 25 patients. Among 55 distal subtotal gastrectomies, gastroduodenostomy was performed in 47 patients while gastrojejunostomy was in 8. Mean operation time was 226 minutes. There was no operative mortality while there were two conservatively treated wound complications and 1 postoperative leakage. The restoration of bowel sound was noted on 2.9 postoperative days, soft diet was started form 4.1 postoperative days and the mean duration of hospital stay was 6.4 days.
There were 37 mucosal, 33 submucosal, 3 muscular, 3 subserosal, and 4 serosal lesions. None of the specimen showed microscopic tumor involvement in the resection line. The mean number of retrieved lymph nodes was 37 (range=7~83). Lymph node metastases were noted in ten patients with one mucosal, five submucosal, one subserosal, and three serosal cancers.
Conclusions: From our experience of robotic gastrectomy, robotic surgery can be applied safely and effectively for the patients with early gastric cancer. Robotic gastrectomy showed quite similar early postoperative outcomes to that of conventional laparoscopic gastrectomy. However, a prospective randomized study comparing the shot-term and long-term surgical outcomes between robotic and laparoscopic gastrectomy is needed.

Session: Podium Presentation

Program Number: S072

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