Clinical Application of Image-Enhanced Minimally Invasive Robotic Surgery for Gastric Cancer: A Prospective Observational Study
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This study was performed to validate the feasibility and role of image-guided robotic surgery using preoperative computed tomography (CT) images for the treatment of gastric cancer.
Twelve patients scheduled to undergo robotic gastrectomy for gastric cancer were registered. Vessels encountered during gastrectomy were reconstructed using 3D software and their anatomical variation was evaluated using preoperatively performed CT-angiography. The vascular information was transferred to a robot console using a multi-input display mode. Radiologic findings acquired from preoperative CT by the radiologist were compared with intraoperative findings of the surgeon. This study is registered with www.clinicaltrials.gov as NCT01338948.
All 12 robotic gastrectomies were performed without any problems. All anatomical data acquired using 3D software were transferred successfully during surgery. Intraoperative vascular images depicted vasculatures around the stomach and could identify important vascular variations. During surgery, relevant vascular information led the surgeon to branch sites and facilitated lymphadenectomy around the vessels. Image-guidance during the operation provided a vascular map and enabled the surgeon to avoid accidental bleeding and damage to other organs by preventing vascular injuries.
Image-guided robotic surgery for gastric cancer using preoperative CT-angiography reconstructed during operation by a surgically trained radiologist who could adjust the images by anticipating the operative procedure was feasible and improved the efficiency of surgery by eliminating the possibility of vascular injuries.
KeywordsImage-guided surgery Robotic gastrectomy CT-angiography
The authors thank Dong-Su Jang Research Assistant, Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea for his work on the illustrations of this article. The authors thank Katherine M Stefani English Editor, Yonsei University College of Medicine, Seoul, Korea for her work on the English proofreading of this article. This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health and Welfare, Republic of Korea (1020410).
Navigation for the omental branches of left gastroepiploic vessels. (WMV 7004 kb)
Navigation for the right gastroepiploic vein. (WMV 10301 kb)
Navigation for the right gastroepiploic artery and infrapyloric artery. (WMV 6216 kb)
Navigation for the right gastric artery. (WMV 8974 kb)
Navigation for the left gastric vein. (WMV 9552 kb)
Navigation for the left gastric artery. (WMV 9142 kb)
- 3.Benabid AL, Hoffmann D, Le Bas JF, Lavallee S. Value of image guided neurosurgery in neuro-oncology. Bull Cancer 1995;82 Suppl 5:573 s-580 s.Google Scholar
- 12.Kumano S, Tsuda T, Tanaka H, et al. Preoperative evaluation of perigastric vascular anatomy by 3-dimensional computed tomographic angiography using 16-channel multidetector-row computed tomography for laparoscopic gastrectomy in patients with early gastric cancer. J Comput Assist Tomogr 2007;31(1):93–97.PubMedCrossRefGoogle Scholar
- 17.Hong K, Georgiades CS, Geschwind JF. Technology insight: Image-guided therapies for hepatocellular carcinoma--intra-arterial and ablative techniques. Nat Clin Pract Oncol 2006;3(6):315–324.Google Scholar