title: The robotic third arm as a competent analog of an assisting surgeon in radical gastrectomy: impact on short-term clinical outcomes.
abstract: BACKGROUND
  Robotic surgery was invented to overcome difficulties associated with conventional laparoscopic surgery. However, ways in which to improve the efficacy of such surgery have not yet been discussed. This report focuses on the role of a robotic third arm in maximizing the efficacy of lymph node dissection in robot-assisted gastrectomy.
  
  
  METHODS
  Thirty-five robotic gastrectomies were performed between April 2009 and December 2010. We evaluated our surgical procedures by reviewing video recordings of robotic operations and analyzed the steps involved in lymph node dissections frame by frame. Then, we analyzed the short-term clinical outcomes to look at the impact of standardized use of the third arm on clinical outcomes. The initial 15 cases (Group A) were compared with 20 later cases (Group B) in terms of postoperative inflammation and pancreatitis.
  
  
  RESULTS
  The clinicopathologic characteristics, including operation type, hospital stay, morbidity, and pathological features, were not different between the two groups. However, postoperative serum amylase levels as well as drain amylase levels were significantly lower in Group B than in Group A (P<.05). The incidence of postoperative pancreatic fistula was also lower in Group B (P<.05).
  
  
  CONCLUSIONS
  Gastrectomy with extragastric lymph node dissection using the da Vinci(®) Surgical System (Intuitive Surgical, Sunnyvale, CA) can be performed safely and effectively with the appropriate and sophisticated use of a robotic third arm.
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Shim
authors.forename: Jun Gi
authors.initials: JG
authors.lastname: Kim
authors.forename: Hae Myung
authors.initials: HM
authors.lastname: Jeon
authors.forename: Cho Hyun
authors.initials: CH
authors.lastname: Park
authors.forename: Kyo Young
authors.initials: KY
authors.lastname: Song
mesh_terms: D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012371:Robotics / Q000295:instrumentation*; D013997:Time Factors; D016896:Treatment Outcome