Journal of Gastrointestinal Surgery

, Volume 17, Issue 2, pp 304–312 | Cite as

Clinical Application of Image-Enhanced Minimally Invasive Robotic Surgery for Gastric Cancer: A Prospective Observational Study

  • Yoo Min Kim
  • Song-Ee Baek
  • Joon Seok Lim
  • Woo Jin HyungEmail author
Original Article



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 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.


Image-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).

Supplementary material

Video 1

Navigation for the omental branches of left gastroepiploic vessels. (WMV 7004 kb)

Video 2

Navigation for the right gastroepiploic vein. (WMV 10301 kb)

Video 3

Navigation for the right gastroepiploic artery and infrapyloric artery. (WMV 6216 kb)

Video 4

Navigation for the right gastric artery. (WMV 8974 kb)

Video 5

Navigation for the left gastric vein. (WMV 9552 kb)

Video 6

Navigation for the left gastric artery. (WMV 9142 kb)


  1. 1.
    Gybels J, Suetens P. Image-guided surgery. Verh K Acad Geneeskd Belg 1997;59(1):35–57; discussion 57–39PubMedGoogle Scholar
  2. 2.
    Vannier MW, Haller JW. Navigation in diagnosis and therapy. Eur J Radiol 1999;31(2):132–140.PubMedCrossRefGoogle Scholar
  3. 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
  4. 4.
    Sugimoto M, Yasuda H, Koda K, et al. Image overlay navigation by markerless surface registration in gastrointestinal, hepatobiliary and pancreatic surgery. J Hepatobiliary Pancreat Sci 2010;17(5):629–636.PubMedCrossRefGoogle Scholar
  5. 5.
    Rassweiler J, Baumhauer M, Weickert U, et al. The role of imaging and navigation for natural orifice translumenal endoscopic surgery. J Endourol 2009;23(5):793–802.PubMedCrossRefGoogle Scholar
  6. 6.
    Lim JS, Hyung WJ, Park MS, Kim MJ, Noh SH, Kim KW. Imaging-guided minimally invasive laparoscopic resection of intraluminal small-bowel tumor: report of two cases. AJR Am J Roentgenol 2007;189(1):56–60.PubMedCrossRefGoogle Scholar
  7. 7.
    Marescaux J, Solerc L. Image-guided robotic surgery. Seminars in laparoscopic surgery 2004;11(2):113–122.PubMedGoogle Scholar
  8. 8.
    Maciunas RJ. Computer-assisted neurosurgery. Clin Neurosurg 2006;53:267–271.PubMedGoogle Scholar
  9. 9.
    Yeniaras E, Deng Z, Syed MA, Davies MG, Tsekos NV. A novel virtual reality environment for preoperative planning and simulation of image guided intracardiac surgeries with robotic manipulators. Stud Health Technol Inform 2011;163:716–722.PubMedGoogle Scholar
  10. 10.
    Shamir R, Freiman M, Joskowicz L, Shoham M, Zehavi E, Shoshan Y. Robot-assisted image-guided targeting for minimally invasive neurosurgery: planning, registration, and in-vitro experiment. Med Image Comput Comput Assist Interv 2005;8(Pt 2):131–138.PubMedGoogle Scholar
  11. 11.
    Chandra V, Dutta S, Albanese CT. Surgical robotics and image guided therapy in pediatric surgery: emerging and converging minimal access technologies. Semin Pediatr Surg 2006;15(4):267–275.PubMedCrossRefGoogle Scholar
  12. 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
  13. 13.
    Matsuki M, Tanikake M, Kani H, et al. Dual-phase 3D CT angiography during a single breath-hold using 16-MDCT: assessment of vascular anatomy before laparoscopic gastrectomy. AJR Am J Roentgenol 2006;186(4):1079–1085.PubMedCrossRefGoogle Scholar
  14. 14.
    Hawkes DJ, Barratt D, Blackall JM, et al. Tissue deformation and shape models in image-guided interventions: a discussion paper. Med Image Anal 2005;9(2):163–175.PubMedCrossRefGoogle Scholar
  15. 15.
    Song J, Oh SJ, Kang WH, Hyung WJ, Choi SH, Noh SH. Robot-assisted gastrectomy with lymph node dissection for gastric cancer: lessons learned from an initial 100 consecutive procedures. Ann Surg 2009;249(6):927–932.PubMedCrossRefGoogle Scholar
  16. 16.
    Ahrar K, Wallace M, Javadi S, Gupta S. Mediastinal, hilar, and pleural image-guided biopsy: current practice and techniques. Semin Respir Crit Care Med 2008;29(4):350–360.PubMedCrossRefGoogle Scholar
  17. 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
  18. 18.
    Matsuki M, Kanazawa S, Kanamoto T, et al. Virtual CT gastrectomy by three-dimensional imaging using multidetector-row CT for laparoscopic gastrectomy. Abdom Imaging 2006;31(3):268–276.PubMedCrossRefGoogle Scholar
  19. 19.
    Pandya S, Motkoski JW, Serrano-Almeida C, Greer AD, Latour I, Sutherland GR. Advancing neurosurgery with image-guided robotics. J Neurosurg 2009;111(6):1141–1149.PubMedCrossRefGoogle Scholar
  20. 20.
    Paul HA, Bargar WL, Mittlestadt B, et al. Development of a surgical robot for cementless total hip arthroplasty. Clin Orthop Relat Res 1992(285):57–66.PubMedGoogle Scholar
  21. 21.
    Tseng CS, Chung CW, Chen HH, Wang SS, Tseng HM. Development of a robotic navigation system for neurosurgery. Stud Health Technol Inform 1999;62:358–359.PubMedGoogle Scholar
  22. 22.
    Woo Y, Hyung WJ, Pak KH, et al. Robotic gastrectomy as an oncologically sound alternative to laparoscopic resections for the treatment of early-stage gastric cancers. Arch Surg 2011;146(9):1086–1092.PubMedCrossRefGoogle Scholar
  23. 23.
    Cleary K, Peters TM. Image-guided interventions: technology review and clinical applications. Annu Rev Biomed Eng 2010;12:119–142.PubMedCrossRefGoogle Scholar
  24. 24.
    Kwartowitz DM, Miga MI, Herrell SD, Galloway RL. Towards image guided robotic surgery: multi-arm tracking through hybrid localization. Int J Comput Assist Radiol Surg 2009;4(3):281–286.PubMedCrossRefGoogle Scholar
  25. 25.
    Mirota DJ, Ishii M, Hager GD. Vision-based navigation in image-guided interventions. Annu Rev Biomed Eng 2011;13:297–319.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2012

Authors and Affiliations

  • Yoo Min Kim
    • 1
  • Song-Ee Baek
    • 2
  • Joon Seok Lim
    • 2
  • Woo Jin Hyung
    • 1
    • 3
    • 4
    Email author
  1. 1.Department of SurgeryYonsei University College of MedicineSeoulKorea
  2. 2.Department of RadiologyYonsei University College of MedicineSeoulKorea
  3. 3.Brain Korea 21 Project for Medical ScienceYonsei University College of MedicineSeoulKorea
  4. 4.Robot and Minimally Invasive Surgery Center, Severance HospitalYonsei University Health SystemSeoulKorea

Personalised recommendations