title: Full robot-assisted gastrectomy: surgical technique and preliminary experience from a single center.
abstract: The treatment of gastric cancer requires a multidisciplinary approach in which surgery plays the main role. The diffusion of minimally invasive surgery for gastric cancer treatment is limited by the complexity of performing an extended lymphadenectomy. This surgical step can be facilitated through the use of a robot-assisted system. To date, there are few published articles discussing a full robotic approach that precisely show the different surgical steps. The aim of this study is to describe our experience, surgical techniques and the short-term results of a consecutive series of full robotic gastrectomies using the Da Vinci Surgical System. From November 2011 to January 2015, 17 patients with gastric cancer underwent curative resection by robotic approach for locally advanced tumors. In summary, there were 15 total gastrectomies with a Roux-en-Y esophagojejunostomy, one total gastrectomy with transverse colectomy and one sub-total gastrectomy. Resection margins were negative in all cases. Conversions occurred in two patients. Robot-assisted gastrectomy with extended lymphadenectomy is a safe technique and successfully allows an adequate lymph node harvest and optimal R0-resection rates with low postoperative morbidity. The learning curve appears to be shorter than in laparoscopic surgery. Further follow-up and randomized clinical trials are required to confirm the role of a robotic approach in gastric cancer surgery.
authors.affiliation: General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña nº 10, 28050, Madrid, Spain.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Quijano
authors.affiliation: General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña nº 10, 28050, Madrid, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Vicente
authors.affiliation: General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña nº 10, 28050, Madrid, Spain.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Ielpo
authors.affiliation: General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña nº 10, 28050, Madrid, Spain.
authors.forename: Hipolito
authors.initials: H
authors.lastname: Duran
authors.affiliation: General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña nº 10, 28050, Madrid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Diaz
authors.affiliation: General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña nº 10, 28050, Madrid, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Fabra
authors.affiliation: General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña nº 10, 28050, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Malave
authors.affiliation: General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña nº 10, 28050, Madrid, Spain.
authors.forename: Valentina
authors.initials: V
authors.lastname: Ferri
authors.affiliation: General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña nº 10, 28050, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ferronetti
authors.affiliation: Department of Pathology, Sanchinarro University Hospital, San Pablo University, CEU, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Plaza
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: D'Andrea
authors.affiliation: General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña nº 10, 28050, Madrid, Spain. ricaruso2@gmail.com.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Caruso
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D000069287:Capecitabine / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007262:Infusions, Intravenous; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D019990:Perioperative Care / Q000379:methods; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000601:surgery*; D055815:Young Adult
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D015251:Epirubicin; D000069287:Capecitabine
keywords: Gastric cancer; Minimally invasive surgery; Reconstruction; Robotic gastrectomy; Robotic gastric cancer; Total gastrectomy