title: Safety and feasibility of reduced-port robotic distal gastrectomy for gastric cancer: a phase I/II clinical trial.
abstract: BACKGROUND
  Theoretically, reducing the number of ports required in minimally invasive surgery for gastric cancer would further minimize trauma associated therewith. Advances in single-site surgery have afforded surgeons the ability to perform reduced-port distal gastrectomy via a robotic approach using the Single-Site™ system, eliminating restrictions on the movement of surgical instruments.
  
  
  METHODS
  This phase I/II study was designed as a single-arm prospective trial of reduced-port robotic distal gastrectomy (RRDG) by a single surgeon (NCT02347956). From January to October 2015, 40 individuals scheduled to undergo robotic surgery for early gastric cancer were asked to participate in the trial. Nineteen were enrolled and underwent RRDG. The primary endpoints were 30-day morbidity and mortality.
  
  
  RESULTS
  No intraoperative event requiring conversion to laparoscopic or open surgery occurred, and no major complication was observed following RRDG (0.0% [80% CI (0.0-11.4%)]). Medians of operation time, blood loss, the number of retrieved lymph nodes, days until gas passing, and hospital stay were 190 min, 20 mL, 48, 3, and 5 days, respectively.
  
  
  CONCLUSIONS
  Deemed safe and feasible through the present trial, RRDG could be a valid alternative to conventional robot distal gastrectomy for managing early gastric cancer. Our reduced-port robotic surgery using the Single-Site system and a third robotic arm could potentially be applicable as a highly advanced, minimally invasive surgery for other solid organ diseases.
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, South Korea.
authors.forename: Seungho
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, South Korea.
authors.forename: Jin Kyong
authors.initials: JK
authors.lastname: Kim
authors.affiliation: Department of Biostatistics, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Youn Nam
authors.initials: YN
authors.lastname: Kim
authors.affiliation: Department of Sculpture, Hongik University, Seoul, South Korea.
authors.forename: Dong-Su
authors.initials: DS
authors.lastname: Jang
authors.affiliation: Department of Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea.
authors.forename: Yoo Min
authors.initials: YM
authors.lastname: Kim
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, South Korea.
authors.forename: Taeil
authors.initials: T
authors.lastname: Son
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, South Korea.|Minimally Invasive Surgery Center, Yonsei University Health System, Seoul, South Korea.
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Hyung
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, South Korea. cairus@yuhs.ac.|Minimally Invasive Surgery Center, Yonsei University Health System, Seoul, South Korea. cairus@yuhs.ac.|Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei University Health System, Seoul, South Korea. cairus@yuhs.ac.
authors.forename: Hyoung-Il
authors.identifier: http://orcid.org/0000-0002-6134-4523
authors.initials: HI
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000295:instrumentation; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data*; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D065287:Robotic Surgical Procedures; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: Early Gastric Cancer; Intuitive Surgical; Needle Driver; Retrieve Lymph Node; Visual Analogue Scale Score