Delta-shaped anastomosis in totally robotic Billroth I gastrectomy: technical aspects and short-term outcomes.
BACKGROUND
Delta-shaped anastomosis has been recognized as a method of intracorporeal Billroth I anastomosis in totally laparoscopic distal gastrectomy. However, the technical aspects and outcomes of the delta-shaped anastomosis in totally robotic distal gastrectomy have never been reported.


METHODS
A single-institutional, non-randomized, retrospective study was performed between 2009 and 2013. During the study period, 47 patients underwent robotic distal gastrectomy followed by robotic delta-shaped Billroth I reconstruction, and 165 patients underwent conventional laparoscopic distal gastrectomy followed by laparoscopic delta-shaped Billroth I reconstruction. After 64 were excluded because of insufficient intraoperative video, 43 patients in the robotic group and 105 patients in the laparoscopic group were enrolled in the study. Short-term outcomes were determined from medical records and full-length operative videos.


RESULTS
There were no significant differences between the robotic and laparoscopic groups in terms of morbidity (4.7% vs 3.8%), anastomosis-related complications (0% vs 1.0%), non-anastomosis-related complications (2.3% vs 0%), or systemic complications (2.3% vs 0%). Time for reconstruction did not vary between the robotic group (16.6 min [8.8-42.9 min]) and the laparoscopic group (15.8 min [7.2-41.0 min]). There was no mortality in this series. In the conventional group, the morbidity rate was 3.8%. The anastomosis-related complication rate was 1.0% in the conventional group.


CONCLUSIONS
Given the excellent short-term outcomes related to anastomosis, delta-shaped anastomosis after robotic distal gastrectomy was at least as feasible and safe as delta-shaped anastomosis after laparoscopic distal gastrectomy.
Division of Upper GI, Department of Surgery, Fujita Health University, Toyoake, Japan.
Kenji
K
Kikuchi
Division of Upper GI, Department of Surgery, Fujita Health University, Toyoake, Japan. ko-suda@nifty.com.
Koichi
K
Suda
Division of Upper GI, Department of Surgery, Fujita Health University, Toyoake, Japan.
Masaya
M
Nakauchi
Division of Upper GI, Department of Surgery, Fujita Health University, Toyoake, Japan.
Susumu
S
Shibasaki
Division of Upper GI, Department of Surgery, Fujita Health University, Toyoake, Japan.
Kenichi
K
Nakamura
Division of Upper GI, Department of Surgery, Fujita Health University, Toyoake, Japan.
Shuhei
S
Kajiwara
Division of Upper GI, Department of Surgery, Fujita Health University, Toyoake, Japan.
Ai
A
Goto
Division of Upper GI, Department of Surgery, Fujita Health University, Toyoake, Japan.
Kazuki
K
Inaba
Division of Upper GI, Department of Surgery, Fujita Health University, Toyoake, Japan.
Yoshinori
Y
Ishida
Division of Upper GI, Department of Surgery, Fujita Health University, Toyoake, Japan.
Ichiro
I
Uyama
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005763:Gastroenterostomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
Billroth-I reconstruction; delta-shaped anastomosis; robotic gastrectomy