title: Full robotic gastrectomy with extended (D2) lymphadenectomy for gastric cancer: surgical technique and preliminary results.
abstract: BACKGROUND
  Widespread diffusion of minimally-invasive surgery for gastric cancer treatment is limited by the complexity of performing an extended D2-lymphadenectomy. This surgical step can be facilitated by using robot-assisted surgery. The aim of this study is to describe our technique and short-term results of a consecutive series of full robotic gastrectomies with D2-lymphadenectomy for gastric cancer, using the da Vinci Surgical System.
  
  
  METHODS
  Between May 2004 and December 2009, we performed 24 consecutive full robot-assisted total and subtotal gastrectomies with extended D2-lymphadenectomy for histologically-proven gastric adenocarcinoma. Data referring to 11 robot-assisted total gastrectomies and 13 subtotal gastrectomies were collected in a database and analyzed.
  
  
  RESULTS
  Median operative time was 267.50 min (255-305). Median intraoperative blood loss was 30 mL. Median number of harvested lymph nodes was 28 (23-34). Resection margins were negative in all cases. No conversions occurred. Surgery-related morbidity was 8%. Thirty-day mortality was 0%. Liquid diet started on postoperative d 5 (2-5). Median length of stay was 6 d (5-8).
  
  
  CONCLUSIONS
  Robot-assisted gastrectomy with D2-lymphadenectomy is a safe technique and allows achieving an adequate lymph node harvest and optimal R0-resection rates with low postoperative morbidity and the learning curve appears to be shorter than in laparoscopic surgery. Longer follow-up and randomized clinical trials are needed to define the role of robot-assistance in gastric cancer surgery.
authors.affiliation: Azienda Ospedaliera S Giovanni-Addolorata, Rome, Italy.
authors.forename: Annibale
authors.initials: A
authors.lastname: D'Annibale
authors.forename: Vito
authors.initials: V
authors.lastname: Pende
authors.forename: Graziano
authors.initials: G
authors.lastname: Pernazza
authors.forename: Igor
authors.initials: I
authors.lastname: Monsellato
authors.forename: Paolo
authors.initials: P
authors.lastname: Mazzocchi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Lucandri
authors.forename: Emilio
authors.initials: E
authors.lastname: Morpurgo
authors.forename: Tania
authors.initials: T
authors.lastname: Contardo
authors.forename: Gianna
authors.initials: G
authors.lastname: Sovernigo
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D016063:Blood Loss, Surgical; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods; D008197:Lymph Node Excision / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D010865:Pilot Projects; D012371:Robotics / Q000379:methods*; D013274:Stomach Neoplasms / Q000601:surgery*; D020858:Tissue and Organ Harvesting / Q000379:methods