title: Initial experience of robotic gastrectomy and comparison with open and laparoscopic gastrectomy for gastric cancer.
abstract: BACKGROUND
  Robotic gastrectomy has become more popular in the treatment of gastric cancer, especially in Asian countries. Until now, few studies have compared robotic surgery with open or laparoscopic surgery for gastric cancer patients.
  
  
  METHODS
  Data were prospectively collected between January 2006 and February 2012. A total of 689 patients underwent curative resection of adenocarcinoma of the stomach. Patients were separated into three groups according to the different surgical approaches used (586 open, 64 laparoscopic, and 39 robotic). The clinicopathological characteristics and surgical outcomes of the three groups were compared.
  
  
  RESULTS
  The open group was associated with a larger tumor size, more D2 dissection, more advanced tumor stage, and more blood loss than the groups treated with laparoscopic and robotic methods. Robotic gastrectomy was associated with female predominance, less blood loss, shorter hospital stay, and longer operative time than open and laparoscopic gastrectomy. The retrieved lymph node numbers were similar between the open and robotic groups. Postoperative morbidity rates were similar among the three groups. In terms of the learning curve of robotic gastrectomy, operative time and docking time were significantly reduced in the recent robotic group (n=14) compared to the initial robotic group (n=25).
  
  
  CONCLUSIONS
  Robotic gastrectomy could achieve extended lymph node dissection similar to open surgery. Our results showed a significant learning curve effect in the initial 25 cases of the robotic group.
authors.affiliation: Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, 201 Section 2 Shih-Pai Road, Taipei, 11217, Taiwan.
authors.forename: Kuo-Hung
authors.initials: KH
authors.lastname: Huang
authors.forename: Yuan-Tzu
authors.initials: YT
authors.lastname: Lan
authors.forename: Wen-Liang
authors.initials: WL
authors.lastname: Fang
authors.forename: Jen-Hao
authors.initials: JH
authors.lastname: Chen
authors.forename: Su-Shun
authors.initials: SS
authors.lastname: Lo
authors.forename: Mao-Chih
authors.initials: MC
authors.lastname: Hsieh
authors.forename: Anna Fen-Yau
authors.initials: AF
authors.lastname: Li
authors.forename: Shih-Hwa
authors.initials: SH
authors.lastname: Chiou
authors.forename: Chew-Wun
authors.initials: CW
authors.lastname: Wu
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005260:Female; D005743:Gastrectomy / Q000379:methods* / Q000523:psychology; D006801:Humans; D010535:Laparoscopy / Q000523:psychology; D059032:Learning Curve; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012371:Robotics; D017678:Sex Distribution; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome