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Feasibility of robotic radical gastrectomy using a monopolar device for gastric cancer

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Abstract

Purposes

Laparoscopic gastrectomy using ultrasonic devices occasionally causes postoperative pancreatic fistula. Robotic gastrectomy using monopolar scissors may reduce intraoperative injury to the pancreas. We evaluated the safety and feasibility of robotic gastrectomy.

Methods

A multicenter prospective study was conducted to evaluate the surgical outcomes of robotic gastrectomy. The primary endpoints were the incidence of intraoperative and postoperative complications and operative mortality.

Results

A total of 115 patients were enrolled. The clinical T stages were T1 in 68 patients and T2 or higher in 47 patients. The types of surgery included distal gastrectomy (n = 72), total gastrectomy (n = 39), and proximal gastrectomy (n = 4). Two patients developed intraoperative complications (1.7%), but no cases required conversion to open surgery. The amylase concentration in drainage fluid was higher in cases with pancreatic compression, especially in those with compression for longer than 20 min. Postoperative complications of Clavien–Dindo grade ≥ II occurred in 11 patients (9.6%). There was no mortality. A multivariate analysis indicated that a high body mass index and pancreatic compression by an assistant for longer than 20 min were independent risk factors for postoperative complications (P = 0.029 and P = 0.010).

Conclusions

Robotic gastrectomy using monopolar scissors is safe and feasible. Robotic dissection without compression of the pancreas may reduce postoperative complications.

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Funding

This work was supported by operating support grants from Kyoto University.

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Authors and Affiliations

  1. Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Hiroshi Okabe, Kazutaka Obama, Shigeru Tsunoda, Eiji Tanaka, Shigeo Hisamori & Yoshiharu Sakai

  2. Department of Gastroenterological Surgery, New Tokyo Hospital, Matsudo, Japan

    Hiroshi Okabe

  3. Department of Surgery, Otsu City Hospital, Otsu, Japan

    Hiroshi Okabe

  4. Department of Surgery, Kyoto City Hospital, Kyoto, Japan

    Kazutaka Obama & Koichi Matsuo

  5. Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Japan

    Eiji Tanaka

Authors
  1. Hiroshi Okabe
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  2. Kazutaka Obama
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  3. Shigeru Tsunoda
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  4. Koichi Matsuo
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  5. Eiji Tanaka
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  6. Shigeo Hisamori
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  7. Yoshiharu Sakai
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Contributions

OH contributed to the conception, data acquisition, analysis, and writing the manuscript. OK contributed to the conception, data acquisition, analysis, interpretation of data, and revision. MK contributed to the data acquisition. TS, TE, HS, and SY contributed to the interpretation of data and revision.

Corresponding author

Correspondence to Hiroshi Okabe.

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Conflict of interest

The authors declare no conflicts of interest in association with the present study.

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Supplemental Fig.

 1. A scatter diagram of the amylase concentrations in drainage fluid and the compression time of the pancreas. Spearman’s rank correlation coefficient (rs) was 0.373 indicating a weak correlation between the two values. Five plots with amylase concentrations of > 5000 were not shown in this figure but were included in the calculation of the correlation coefficient (TIFF 2947 kb)

Supplementary material 2 (DOC 45 kb)

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Okabe, H., Obama, K., Tsunoda, S. et al. Feasibility of robotic radical gastrectomy using a monopolar device for gastric cancer. Surg Today 49, 820–827 (2019). https://doi.org/10.1007/s00595-019-01802-z

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  • DOI: https://doi.org/10.1007/s00595-019-01802-z

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