Robot-assisted laparoscopic total and partial gastric resection with D2 lymph node dissection for adenocarcinoma.
BACKGROUND
Lymph node dissection and esophageal anastomosis, considered the more demanding steps of laparoscopic gastrectomy for gastric adenocarcinoma, can be performed with the use of a remote-controlled robot.


METHODS
Thirteen patients with a histologically proved gastric cancer (six stage I, six stage II, and one stage III) were enrolled in a prospective study to assess feasibility and safety of the Da Vinci surgical system in total and partial gastrectomy with extended lymph node dissection. Outcome measures were conversion rate, intra- and postoperative morbidity and mortality, operative time, blood loss, number of lymph nodes harvested, and macroscopic and microscopic evaluation of resection margins.


RESULTS
Eight distal, four total, and one proximal laparoscopic gastrectomies were completed without conversion. Extended lymph node dissection, and esophagojejunal and esophagogastric anastomoses were successfully carried out using the da Vinci System. Mean operative time was 286 +/- 32.6 min and blood loss was 103 +/- 87.5 ml. Mean number of nodes retrieved was 28.1 +/- 8.3 and all resection margins were negative. There was no mortality. Trocar bleeding requiring laparoscopy was the only major complication encountered. No recurrence occurred during a mean follow-up time of 12.2 +/- 4.5 months.


CONCLUSIONS
Robot-assisted laparoscopic lymph node dissection and esophageal anastomosis are feasible and safe. Longer follow-up time and randomized studies are needed to evaluate long-term outcome and clinical advantages of this new technology.
Patriti
Alberto
A
Department of General, Vascular, Minimally Invasive and Robotic Surgery, San Matteo degli Infermi Hospital-Spoleto, Via Loreto, 3, 06049, Spoleto, Perugia, Italy. albertopatriti@gmail.com
Ceccarelli
Graziano
G
Bellochi
Raffaele
R
Bartoli
Alberto
A
Spaziani
Alessandro
A
Di Zitti
Lelio
L
Casciola
Luciano
L
D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011446:Prospective Studies; D012371:Robotics / Q000379:methods*; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*