title: Robotic digestive tract reconstruction after total gastrectomy for gastric cancer: a simple way to do it.
abstract: BACKGROUND
  Intracorporeal digestive tract reconstruction after minimally invasive total gastrectomy may be challenging, even when using the da Vinci® Surgical System. This may be due to intrinsic difficulties during oesophago-jejunal anastomosis (EJA). The aim of this study was to describe a simple way to perform digestive tract reconstruction after robotic total gastrectomy (RTG) for gastric cancer and the results of its application in a small series of cases.
  
  
  METHODS
  In the last 2 years, six patients with gastric adenocarcinoma have been treated by RTG, four male and two female, with mean age of 59.8 (range 48-74) years. The tumour was located in the gastric body in three patients, the gastric antrum in two patients and the fundus in one patient with no need of splenectomy. In all cases, D2 lymphadenectomy was completed. A modified robotic reconstruction technique proposed by the authors was used in these operations, which consists in a latero-lateral EJA using a linear stapler. An entero-enterostomy is also performed in the upper abdomen.
  
  
  RESULTS
  The mean operative time was 408 (range 340-481) min. The mean time for digestive tract reconstruction was 57 (range 47-68) min. There were no conversions to open or laparoscopic surgery. The number of lymph nodes removed varied in the range 28-52 (average 40). There was no mortality. Postoperative staging showed three T1N0M0s, one T2N0M0, one T3N0M0 and one T3N2M0.
  
  
  CONCLUSIONS
  This series, which despite being small, demonstrates that this robotic reconstruction technique is safe, with no major complications, demands a relatively short time for its accomplishment, even when dealing with initial experience. Copyright © 2015 John Wiley & Sons, Ltd.
authors.affiliation: Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine, USP, Brazil.|Gastromed Institute, Av. Nove de Julho, 4.440, Jd. Paulista São Paulo, Brazil.
authors.forename: Leandro Cardoso
authors.initials: LC
authors.lastname: Barchi
authors.affiliation: Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine, USP, Brazil.
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Jacob
authors.affiliation: Gastromed Institute, Av. Nove de Julho, 4.440, Jd. Paulista São Paulo, Brazil.
authors.forename: Maurice Youssef
authors.initials: MY
authors.lastname: Franciss
authors.affiliation: Gastromed Institute, Av. Nove de Julho, 4.440, Jd. Paulista São Paulo, Brazil.
authors.forename: Guilherme Tommasi
authors.initials: GT
authors.lastname: Kappaz
authors.affiliation: Gastromed Institute, Av. Nove de Julho, 4.440, Jd. Paulista São Paulo, Brazil.
authors.forename: Edison Dias
authors.initials: ED
authors.lastname: Rodrigues Filho
authors.affiliation: Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine, USP, Brazil.|Gastromed Institute, Av. Nove de Julho, 4.440, Jd. Paulista São Paulo, Brazil.
authors.forename: Bruno
authors.initials: B
authors.lastname: Zilberstein
mesh_terms: D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D000714:Anastomosis, Surgical; D004947:Esophagus / Q000601:surgery; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D041981:Gastrointestinal Tract / Q000601:surgery*; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008198:Lymph Nodes / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D019651:Plastic Surgery Procedures / Q000379:methods*; D065287:Robotic Surgical Procedures / Q000379:methods*; D013270:Stomach / Q000601:surgery; D013274:Stomach Neoplasms / Q000601:surgery*
keywords: gastric cancer; minimally invasive surgery; reconstruction; robotic gastrectomy; total gastrectomy