title: Full robot-assisted gastrectomy with intracorporeal robot-sewn anastomosis produces satisfying outcomes.
abstract: OBJECTIVE
  To evaluate the feasibility and safety of full robot-assisted gastrectomy with intracorporeal robot hand-sewn anastomosis in the treatment of gastric cancer.
  
  
  METHODS
  From September 2011 to March 2013, 110 consecutive patients with gastric cancer at the authors' institution were enrolled for robotic gastrectomies. According to tumor location, total gastrectomy, distal or proximal subtotal gastrectomy with D2 lymphadenectomy was fully performed by the da Vinci Robotic Surgical System. All construction, including Roux-en-Y jejunal limb, esophagojejunal, gastroduodenal and gastrojejunal anastomoses were fully carried out by the intracorporeal robot-sewn method. At the end of surgery, the specimen was removed through a 3-4 cm incision at the umbilicus trocar point. The details of the surgical technique are well illustrated. The benefits in terms of surgical and oncologic outcomes are well documented, as well as the failure rate and postoperative complications.
  
  
  RESULTS
  From a total of 110 enrolled patients, radical gastrectomy could not be performed in 2 patients due to late stage disease; 1 patient was converted to laparotomy because of uncontrollable hemorrhage, and 1 obese patient was converted due to difficult exposure; 2 patients underwent extra-corporeal anastomosis by minilaparotomy to ensure adequate tumor margin. Robot-sewn anastomoses were successfully performed for 12 proximal, 38 distal and 54 total gastrectomies. The average surgical time was 272.52 ± 53.91 min and the average amount of bleeding was 80.78 ± 32.37 mL. The average number of harvested lymph nodes was 23.1 ± 5.3. All specimens showed adequate surgical margin. With regard to tumor staging, 26, 32 and 46 patients were staged as I, II and III, respectively. The average hospitalization time after surgery was 6.2 d. One patient experienced a duodenal stump anastomotic leak, which was mild and treated conservatively. One patient was readmitted for intra-abdominal infection and was treated conservatively. Jejunal afferent loop obstruction occurred in 1 patient, who underwent re-operation and recovered quickly.
  
  
  CONCLUSIONS
  This technique is feasible and can produce satisfying postoperative outcomes. It is also convenience and reliable for anastomoses in gastrectomy. Full robotic hand-sewn anastomosis may be a minimally invasive technique for gastrectomy surgery.
authors.affiliation: Xin-Xin Liu, Ping Chen, Yan Zhao, Department of Gastrointestinal Surgery, Subei People's Hospital of Jiangsu Province, Yangzhou 225001, Jiangsu Province, China.
authors.forename: Xin-Xin
authors.initials: XX
authors.lastname: Liu
authors.forename: Zhi-Wei
authors.initials: ZW
authors.lastname: Jiang
authors.forename: Ping
authors.initials: P
authors.lastname: Chen
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhao
authors.forename: Hua-Feng
authors.initials: HF
authors.lastname: Pan
authors.forename: Jie-Shou
authors.initials: JS
authors.lastname: Li
mesh_terms: D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000379:methods*; D002681:China; D004946:Esophagostomy; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007582:Jejunostomy; D007902:Length of Stay; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation; D012371:Robotics; D013274:Stomach Neoplasms / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000009:adverse effects; D013536:Suture Techniques / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
keywords: Esophagojejunal anastomosis; Gastric cancer; Robotic surgery; Total gastrectomy