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Reduced-port totally robotic distal subtotal gastrectomy with lymph node dissection for gastric cancer: a modified technique using Single-Site® and two additional ports

Abstract

Background

Reduced-port laparoscopic gastrectomy further minimizes the invasiveness of laparoscopic gastrectomy, thereby improving patient quality of life. However, suboptimal ergonomics and visualization are challenges to performing reduced-port laparoscopy. As the application of a robotic surgical system may help overcome these challenges, the present study was performed to evaluate the short-term outcomes of reduced-port totally robotic distal subtotal gastrectomy.

Method

An initial 40 consecutive gastric cancer patients treated with reduced-port totally robotic distal subtotal gastrectomy with lymph node dissection from February 2016 to February 2017 were retrospectively reviewed. An overturned infraumbilical Single-Site® port and two additional abdominal ports were utilized. Clinicopathological characteristics and short-term surgical outcomes were analyzed to evaluate the safety and feasibility of the procedure.

Result

Patients comprised 23 (57.5%) males and 17 females. Mean age and body mass index were 54 years and 23.7 kg/m2, respectively. Preoperative clinical T stage was early in 22 patients and advanced (T2 or more) in 18 (45%) patients. No conversions to laparoscopic or open surgery and no additional port insertions were required. Eighteen patients (45%) underwent D2 lymph node dissection. All reconstructions after gastrectomy were made intracorporeally, including 34 (85%) Billroth I anastomoses. Mean operative time and blood loss were acceptable (210 min and 49.9 ml, respectively). The mean number of retrieved lymph nodes was 58.8. Postoperative clinical courses were acceptable for all patients, with no grade III or higher complications recorded.

Conclusion

Reduced-port totally robotic distal subtotal gastrectomy with lymph node dissection was successfully applied and provided acceptable short-term postoperative results.

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References

  1. 1.

    Japanese Gastric Cancer Association (2016) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. https://doi.org/10.1007/s10120-016-0622-4

  2. 2.

    Kawamura H, Tanioka T, Kuji M, Tahara M, Takahashi M (2013) The initial experience of dual port laparoscopy-assisted total gastrectomy as a reduced port surgery for total gastrectomy. Gastric Cancer 16(4):602–608. https://doi.org/10.1007/s10120-012-0212-z

  3. 3.

    Kim SM, Ha MH, Seo JE, Kim JE, Choi MG, Sohn TS, Bae JM, Kim S, Lee JH (2015) Comparison of reduced port totally laparoscopic distal gastrectomy (duet TLDG) and conventional laparoscopic-assisted distal gastrectomy. Ann Surg Oncol 22(8):2567–2572. https://doi.org/10.1245/s10434-014-4333-y

  4. 4.

    Kim SM, Ha MH, Seo JE, Kim JE, Choi MG, Sohn TS, Bae JM, Kim S, Lee JH (2016) Comparison of single-port and reduced-port totally laparoscopic distal gastrectomy for patients with early gastric cancer. Surg Endosc 30(9):3950–3957. https://doi.org/10.1007/s00464-015-4706-8

  5. 5.

    Kunisaki C, Makino H, Kimura J, Takagawa R, Ota M, Kosaka T, Akiyama H, Endo I (2015) Application of reduced-port laparoscopic total gastrectomy in gastric cancer preserving the pancreas and spleen. Gastric Cancer 18(4):868–875. https://doi.org/10.1007/s10120-014-0441-4

  6. 6.

    Kunisaki C, Makino H, Yamaguchi N, Izumisawa Y, Miyamato H, Sato K, Hayashi T, Sugano N, Suzuki Y, Ota M, Tsuburaya A, Kimura J, Takagawa R, Kosaka T, Ono HA, Akiyama H, Endo I (2016) Surgical advantages of reduced-port laparoscopic gastrectomy in gastric cancer. Surg Endosc. https://doi.org/10.1007/s00464-016-4916-8

  7. 7.

    Shibao K, Sato N, Higure A, Yamaguchi K (2015) A new oval multichannel port to facilitate reduced port distal gastrectomy. Minim Invasive Ther Allied Technol 24(3):135–140. https://doi.org/10.3109/13645706.2014.985684

  8. 8.

    Inaki N (2015) Reduced port laparoscopic gastrectomy: a review, techniques, and perspective. Asian J Endosc Surg 8(1):1–10. https://doi.org/10.1111/ases.12163

  9. 9.

    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(12):1566–1578. https://doi.org/10.1002/bjs.9242

  10. 10.

    Junfeng Z, Yan S, Bo T, Yingxue H, Dongzhu Z, Yongliang Z, Feng Q, Peiwu Y (2014) Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: comparison of surgical performance and short-term outcomes. Surg Endosc 28(6):1779–1787. https://doi.org/10.1007/s00464-013-3385-6

  11. 11.

    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. https://doi.org/10.1016/j.ejso.2013.09.011

  12. 12.

    Woo Y, Hyung WJ, Pak KH, Inaba K, Obama K, Choi SH, Noh SH (2011) Robotic gastrectomy as an oncologically sound alternative to laparoscopic resections for the treatment of early-stage gastric cancers. Arch Surg 146(9):1086–1092. https://doi.org/10.1001/archsurg.2011.114

  13. 13.

    Lee S, Kim JK, Kim YN, Jang DS, Kim YM, Son T, Hyung WJ, Kim HI (2017) Safety and feasibility of reduced-port robotic distal gastrectomy for gastric cancer: a phase I/II clinical trial. Surg Endosc. https://doi.org/10.1007/s00464-017-5435-y

  14. 14.

    Kim YM, Son T, Kim HI, Noh SH, Hyung WJ (2016) Robotic D2 lymph node dissection during distal subtotal gastrectomy for gastric cancer: toward procedural standardization. Ann Surg Oncol 23(8):2409–2410. https://doi.org/10.1245/s10434-016-5166-7

  15. 15.

    Song J, Oh SJ, Kang WH, Hyung WJ, Choi SH, Noh SH (2009) Robot-assisted gastrectomy with lymph node dissection for gastric cancer. Ann Surg 249(6):927–932. https://doi.org/10.1097/01.sla.0000351688.64999.73

  16. 16.

    Kanaya S, Kawamura Y, Kawada H, Iwasaki H, Gomi T, Satoh S, Uyama I (2011) The delta-shaped anastomosis in laparoscopic distal gastrectomy: analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy. Gastric Cancer 14(4):365–371. https://doi.org/10.1007/s10120-011-0054-0

  17. 17.

    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

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Acknowledgements

The authors thank Jung-A Im, an illustrator, for her work on the illustrations of this article.

Funding

This study was supported by a faculty research grant from Yonsei University College of Medicine (6-2016-0109), and the funding source had no involvement in the study.

Author information

Correspondence to Taeil Son.

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Disclosures

Drs. Won Jun Seo, Taeil Son, Chul Kyu Roh, Minah Cho, Hyoung-Il Kim, and Woo Jin Hyung have no conflicts of interest or financial ties to disclose.

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Cite this article

Seo, W.J., Son, T., Roh, C.K. et al. Reduced-port totally robotic distal subtotal gastrectomy with lymph node dissection for gastric cancer: a modified technique using Single-Site® and two additional ports. Surg Endosc 32, 3713–3719 (2018) doi:10.1007/s00464-018-6208-y

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Keywords

  • Stomach neoplasms
  • Gastrectomy
  • Minimally invasive surgery
  • Robotic
  • Reduced-port