Abstract
Objective
To evaluate the impact of robotic technology on the learning curve for robot-assisted gastrectomy in the initial clinical application stage and to compare RAG with laparoscopic-assisted gastrectomy using a short-term evaluation.
Methods
Between September 2016 and December 2018, 111 consecutive distal gastric cancer patients who were candidates for RAG or LAG were prospectively enrolled. Operative findings, morbidity, oncological findings, and the learning curve were analyzed.
Results
Thirty patients underwent RAG with the da Vinci Si robot system, and eighty-one patients underwent LAG. Blood loss was lower during RAG than during LAG (133.80 ± 95.28 vs. 178.83 ± 98.37, P = 0.046). The operative time for RAG was significantly longer (304.45 ± 42.08 vs. 281.17 ± 32.69, P = 0.015). The number of retrieved lymph nodes (LNs) was greater (37.33 ± 8.25 vs. 32.78 ± 5.98, P = 0.003) with RAG. Notably, RAG had an advantage in the dissection of No. 9 and 11p LNs (3.56 ± 1.76 vs. 2.78 ± 1.30, P = 0.038; 2.48 ± 0.93 vs. 1.99 ± 0.84, P = 0.015, respectively). Severe complications were less frequent in the RAG group (7 (8.6%) vs. 1 (3.3%), P = 0.003). No significant differences in terms of postoperative recovery were found between the two groups. The learning curve for RAG showed that the cumulative sum value decreased from the 10th case, while it decreased from the 28th case in the LAG group.
Conclusion
By means of robotic technology, RAG is better than LAG for the dissection of No. 9 and 11p LNs and for the alleviation of surgical trauma, and the technique is learned more rapidly during the preliminary stage than the LAG technique.
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References
Hu Y, Huang C, Sun Y (2016) Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol 34(12):1350–1357
Shi Y, Xu X, Zhao Y, Qian F, Tang B, Hao Y, Luo H, Chen J, Yu P (2019) Long-term oncologic outcomes of a randomized controlled trial comparing laparoscopic versus open gastrectomy with D2 lymph node.dissection for advanced gastric cancer. Surgery
Hyun MH, Lee CH, Kim HJ, Tong Y, Park SS (2013) Systematic review and meta-analysis of robotic surgery compared with conventional laparoscopic and open resections for gastric carcinoma. Br J Surg 100:1566–1578
Kim Y-W, Reim D, Park JY, Eom BW, Kook M-C, Ryu KW, Yoon HM (2016) Role of robot-assisted distal gastrectomy compared to laparoscopy-assisted distal gastrectomy in suprapancreatic nodal dissection for gastric cancer. Surg Endosc 30(4):1547–1552
Roviello F, Piagnerelli R, Ferrara F, Caputo E, Scheiterle M, Marrelli D (2015) Assessing the feasibility of full robotic interaortocaval nodal dissection for locally advanced gastric cancer. Int J Med Robot 11(2):218–222.
Cianchi F, Indennitate G, Trallori G, Ortolani M, Paoli B, Macrì G, Lami G, Mallardi B, Badii B,Staderini F, Qirici E, Taddei A, Ringressi MN, Messerini L, Novelli L, Bagnoli S, Bonanomi A,Foppa C,Skalamera I, Fiorenza G, Perigli G (2016) Robotic vs laparoscopic distal gastrectomy with D2 lymphadenectomy for gastric cancer: a retrospective comparative mono-institutional study. BMC Surg 16(1):65.
Shen W, Xi H, Wei Bo et al (2016) Robotic versus laparoscopic gastrectomy for gastric cancer: comparison of short-term surgical outcomes. Surg Endosc 30:574–580
Junfeng Z, Yan S, Bo T, Yingxue H, Dongzhu Z et al (2014) Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: comparison of surgical performance and short-term Outcomes. Surg Endosc 28:1779–1787
Jun Lu, Zheng H-L, Li P, Xie J-W et al (2018) A propensity score-matched comparison of robotic versus laparoscopic gastrectomy for gastric cancer: oncological, cost, and surgical stress analysis. J Gastrointest Surg 22:1152–1162
Shen W-S, Xi H-Q, Chen L, Wei Bo (2014) A meta-analysis of robotic versus laparoscopic gastrectomy for gastric cancer. Surg Endosc 28:2795–2802
Association JGC (2011) Japanese classifification of gastric carcinoma: 3rd English edition. Gastric Cancer 14(2):101–112
Yu J, Rao S, Lin Z, Pan Z, Zheng X, Wang Z (2019) The learning curve of endoscopic thyroid surgery for papillary thyroid microcarcinoma: CUSUM analysis of a single surgeon’s experience. Surg Endosc 33(4):1284–1289
Association JGC (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14(2):113–123
Obama K, Kim YM, Kangl DR (2018) Long-term oncologic outcomes of robotic gastrectomy for gastric cancer compared with laparoscopic gastrectomy. Gastric Cancer 21(2):285–295
Yang SY, Roh KH, Kim YN et al (2017) Surgical outcomes after open, laparoscopic, and robotic gastrectomy for gastric cancer. Ann Surg Oncol 24(7):1770–1777
Robotic and Laparoscopic Surgery Committee of Chinese Research Hospital Association (2016) Expert consensus on robotic surgery in gastric cancer (2015 edition). J Chin Res Hosp 3(1):22–28.
Chinese Society of Laparoscopic Surgery, Chinese College of Endoscopists, Chinese Medical Doctor Association; Robotic and Laparoscopic Surgery Committee of Chinese Research Hospital Association; Chinese Laparoscopic Gastrointestinal Surgery Study Group (2017) Expert consensus on quality control of the laparoscopic radical resection for gastric cancer in China (2017 edition). Chin J Digest Surg 16(6):539–547
Sun L-F, Liu K, Su X-S, Wei X, Chen X-L, Zhang W-H, Chen X-Z, Yang K, Zhou Z-G, Hu J-K (2019) Robot-assisted versus laparoscopic-assisted gastrectomy among gastric cancer patients: a retrospective short-term analysis from a single institution in China. Gastroenterol Res Pract 23;2019:9059176.
Junfeng Z, Yan S, Bo T (2014) Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer:comparison of surgical performance and short-term outcomes. Surg Endosc 28(6):1779–1787.
Shen W, Xi H, Wei B (2016) Robotic versus laparoscopic gastrectomy for gastric cancer: comparison of short-term surgical outcomes. Surg Endosc 30(2):574–580
Wang W-J, Li H-T, Yu J-P, Su L, Guo C-A, Chen P, Yan L, Li K, Ma Y-W, Wang L, Hu W, Li Y-M, Liu H-B (2019) Severity and incidence of complications assessed by the Clavien–Dindo classifcation following robotic and laparoscopic gastrectomy for advanced gastric cancer: a retrospective and propensity score-matched study. Surg Endosc 33:3341–3354.
Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ (2010) Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 11:439–449
Kim YW, Reim D, Parketal JY (2016) Role of robot-assisted distal gastrectomy compared to laparoscopy-assisted distal gastrectomy in suprapancreatic nodal dissection for gastric cancer. Surg Endosc 30(4):1547–1552
Wang WJ, Li HT, Yu JP, Su L, Guo CA, Chen P, Yan L, Li K, Ma YW, Wang L, Hu W, Li YM, Liu HB (2018) Severity and incidence of complications assessed by the Clavien-Dindo classification following robotic and laparoscopic gastrectomy for advanced gastric cancer: a retrospective and propensity score-matched study. Surg Endosc
Moorthy K, Munz Y, Dosis A, Hernandez J, Martin S, et al (2004) Dexterity enhancement with robotic surgery. Surg Endosc 18(5):790–795.
Ruurda JP, Broeders IA, Simmermacher RP, Borel Rinkes IH, Van Vroonhoven TJ (2002) Feasibility of robot-assisted laparoscopic surgery: an evaluation of 35 robot-assisted laparoscopic cholecystectomies. Surg Laparosc Endosc Percutaneous Tech 12(1):41–45
Huang K-H, Lan Y-T, Fang W-L (2014) Comparison of the operative outcomes and learning curves between laparoscopic and robotic gastrectomy for gastric cancer. PLoS ONE 9(10):156–163
Kim HI, Park MS, Song KJ, Woo Y, Hyung WJ (2014) Rapid and safe learning of robotic gastrectomy for gastric cancer: multidimensional analysis in a comparison with laparoscopic gastrectomy. Eur J Surg Oncol 40(10):1346–1354
Ielpo B, Duran H, Diaz E (2017) Robotic versus laparoscopic surgery for rectal cancer: a comparative study of clinical outcomes and costs. Int J Colorectal Dis 32(10):1423–1429
Caruso R, Vicente E, Núñez-Alfonsel J, Ferri V, Diaz E, Fabra I, Malave L, Duran H, Isernia R, D’Ovidio A, Pinna E, Ielpo B, Quijano Y (2020) Robotic-assisted gastrectomy compared with open resection: a comparative study of clinical outcomes and cost-efectiveness analysis. J Robot Surg 14(4):627–632.
Acknowledgements
We are grateful for assistance from Yong Liu, Pengzhou Li, Weizhen Li, and Shuxin Wang.
Funding
This study was supported by the National Natural Science Foundation of China (Grant No: 51875580) and the National Key Research and Development Program of Special Project Foundation, China (Grant No: 2017YFC0110402). The supporting source had no involvement in the study design; collection, analysis, and interpretation of data; writing of the report; or the decision to submit the report for publication. The authors have full access to all of the data in this study and take complete responsibility for the integrity of the data and the accuracy of the data analysis.
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Drs. Shaihong Zhu, Jianmin Li, Juan Jiang, and Bo Yi have no conflicts of interest or financial ties to disclose.
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Yi, B., Jiang, J., Zhu, S. et al. The impact of robotic technology on the learning curve for robot-assisted gastrectomy in the initial clinical application stage. Surg Endosc 36, 4171–4180 (2022). https://doi.org/10.1007/s00464-021-08743-0
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DOI: https://doi.org/10.1007/s00464-021-08743-0