title: Robotic valvuloplastic esophagogastrostomy using double flap technique following proximal gastrectomy: technical aspects and short-term outcomes.
abstract: Valvuloplastic esophagogastrostomy by double flap technique (VEG-DFT) is a promising procedure to prevent reflux after proximal gastrectomy (PG), and is achieved by the burial of the abdominal esophagus into the gastric submucosa; however, laparoscopic VEG-DFT is technically demanding due to complicated suturing and ligation maneuvers. The present study was designed to determine the feasibility and safety of robotic VEG-DFT.
  
  
  
  After robotic PG, seromuscular flaps were extracorporeally created at the anterior wall of the remnant stomach through a small umbilical incision. Then, using a robot, the posterior wall of the esophagus was fixed to the cranial end of the mucosal window, and layer-to-layer sutures were placed between the anterior aspects of esophagus and the remnant stomach. Finally, the anastomosis was covered by seromuscular flaps. Short-term outcomes of 12 consecutive patients who underwent VEG-DFT between January 2014 and December 2015 were assessed.
  
  
  
  Operations were successfully completed using robotic assistance in all patients. Median operative, surgeon console, and anastomosis times were 406 (324-613 min), 267 (214-483), and 104 (76-186) min, respectively, and median estimated blood loss was 31 (5-130) ml. The first six cases were required to reach a learning plateau. Both mortality and morbidity rates within 30 days after surgery were 0%. Postoperative hospital stay was 10 (9-30) days. No postoperative reflux esophagitis was observed, whereas anastomotic stenosis, which required endoscopic balloon dilation, developed in three patients (25%) in postoperative month 2. There was a significant association between the total number of stitches used for VEG-DFT and anastomotic stenosis (p < 0.001).
  
  
  
  Robotic assistance may be useful for VEG-DFT with a short learning curve. Attention is required to prevent postoperative anastomotic stenosis possibly caused by an excessive number of stitches for esophagogastrostomy.
authors.affiliation: Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Shibasaki
authors.affiliation: Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan. ko-suda@nifty.com.|Cancer Center, School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582, Japan. ko-suda@nifty.com.
authors.forename: Koichi
authors.initials: K
authors.lastname: Suda
authors.affiliation: Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Nakauchi
authors.affiliation: Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kikuchi
authors.affiliation: Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kadoya
authors.affiliation: Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ishida
authors.affiliation: Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Inaba
authors.affiliation: Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Uyama
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D004946:Esophagostomy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D013274:Stomach Neoplasms / Q000601:surgery; D013524:Surgical Flaps
keywords: Fundoplication; Gastrectomy; Robotic surgical procedure