• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Strategic Plan, 2020-2023
    • Committees
      • Descriptions and Video Updates
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • COVID-19 Announcements
    • SAGES 2020 Meeting Information
    • 2021 Scientific Session Call For Abstracts
    • 2021 Emerging Technology Session Call For Abstracts
    • 2018 Prevent BDI Consensus Conference
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • Leadership Development and Health Policy Conference Videos
      • SAGES Quality Summit Meeting
      • SAGES 2019
      • SAGES 2018
      • SAGES 2017
      • SAGES 2016
      • SAGES 2015
      • SAGES 2014
      • SAGES 2013
    • Related Meetings Calendar
  • Membership
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • COVID-19 Annoucements
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • Troubleshooting Guides
  • Education
    • SAGES.TV Video Library
    • Virtual Hernia Clinic
    • The SAGES Safe Cholecystectomy Program
    • The Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • The SAGES HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Endorsed Courses
    • SAGES Robotics Fellows Courses
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Educational Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES Quality Initiative
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • SAGES Research Opportunities
    • SAGES Endorsed Courses
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
    • Fellowship Certification
  • Search
    • COVID-19 Announcements
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Blog
    • All Blog Posts
    • COVID-19
    • Notes from the Battlefield
    • A (Positive) Way Forward
    • President Posts
  • Log In

Robotic Total Gastrectomy for Advanced Gastric Cancer. Intracorporeal Or Extracorporeal Esophagojejunostomy?

Catalin Vasilescu, MD, PhD, Livia Procopiuc, MD, Monica Popa, Stefan Tudor, MD

Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania

INTRODUCTION – Robotic approach of radical gastric surgery offers a significant technical advantage compared with laparoscopy when performing lymphadenectomy and esophageal anastomoses by reducing the risk of vascular injury, intraoperative bleeding and postoperative anastomotic leak. This study aimed to evaluate the technical options and surgical outcomes of the entirely robotic intracorporeal anastomosis during total gastrectomy for malignant disease.

METHODS AND PROCEDURES – Between May 2008 and August 2012 a total of 48 robotic gastric procedures were performed in our department by a single team. 20 patients (10 female, 10 male age 56.3±13.3)) underwent robotic total gastrectomy: 15 for advanced gastric adenocarcinoma and 5 for non-Hodgkin lymphoma. In all cases a D1+β or D2 lymphadenectomy was performed according to the guidelines of the Japanese Research Society for Gastric Cancer. A preliminary laparoscopic exploration was done in all cases to exclude metastatic disease. The standard reconstruction method was Roux-en-Y eso-jejunoanastomosis using stapling devices. In 14 cases bowel continuity was restored extracorporeally by an end-to-side eso-jejunoanastomosis using a 24 or 25 mm circular stapler and in 6 cases intracorporeally using in 3 cases a double stapling technique and in 3 cases a side-to-side (overlap) technique.

RESULTS –The analysis of operative time and docking time showed a decreasing trend in first 10 cases corresponding to the learning curve. The mean operative time and the mean docking time in the first 10 cases vs. the last 10 cases was 350±43.5 vs. 235±48.9 (p-value=0.023) and 18±5.2 vs. 8±2.4 (p-value=0.035) respectively. The mean blood loss was 85±43.2 ml. There was no statistical difference in operative time between extracorporeal vs. intracorporeal anastomosis (p-value=0.32). There were no conversions or intraoperative problems related to the anastomosis procedure. The mean number of harvested lymph-nodes was 29.2±7.5. Resection margins were negative in all specimens. No surgery-related morbidity and no 30-days mortality were reported. The liquid diet was started 3 day postoperative. The mean hospital stay was 6.5±2.3 days. Planned chemotherapy was started within 3 weeks from surgery.

CONCLUSIONS – Robotic total gastrectomy offers excellent short-term outcomes with no delays in starting planned postoperative chemotherapy. Robotic platform significantly improve the suturing inherent to intracorporeal reconstruction, compared with laparoscopic approach, decrease the risk of traction injuries and increase the number of total intracorporeal esophagojejunostomy. Intracorporeal side-to-side (overlap) technique is especially suitable for reconstruction in the case of a narrow and long esophagus while double stapling technique should be used in case of a short esophagus. Intracorporeal anastomosis during robotic total gastrectomy shows comparable early postoperative outcomes and should be the method of choice particularly in obese patients.


Session: Poster Presentation

Program Number: P639

Post Views: 208

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2013 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Free SAGES Webinar: Lessons from COVID on Living and Thriving as Surgeons

SAGES recognizes that the COVID-19 pandemic has had a big impact on surgical practice and in surgeon wellness. SAGES’ Reimagining the Practice of Surgery Taskforce will present “Finding the Opportunities: Lessons from COVID and How We Live and Thrive as Surgeons”  to look at ways in which innovative leadership at various levels may help transform […]

Daniel Herron, MD

An opportunity to slow down and appreciate the small joys in life

Dan Herron, MD shares insights with Dana Telem, MD on lessons learned from COVID-19 Fear, anxiety and uncertainty has dominated the first half of 2020. Never before have we, as healthcare providers, been asked to do so much with so little—whether it’s resources like personal protective equipment, dusting off skills related to critical care, or […]

covid testing stock

Notes from the Battlefield – May 14, 2020

Coronavirus Global Surgical Collaborative (CVGSC)* An initiative sponsored by SAGES in collaboration with EAES, AEC, KSELS, and ELSA A group of surgical leaders from affected countries have joined to discuss what they are learning during this Covid-19 Global crisis. The following is a brief summary of what they feel may be useful information to disseminate to the surgical […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Newsletter Subscription

  • This field is for validation purposes and should be left unchanged.

Important Links

SAGES 2020 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

[footer_backtotop] · Log in

Copyright © 2021 Society of American Gastrointestinal and Endoscopic Surgeons · Legal
· Managed by BSC Management, Inc