Robotic surgery for gastric tumor: current status and new approaches

Abstract

Surgical techniques have evolved tremendously over this past century. To maximize the efficacy and minimize the invasiveness of laparoscopic surgery, researchers have sought to implement wider application of robotics. Nevertheless, both optimism without sound evidence and fear of new technology obscure the appropriate uses of robotic surgery. In the present review, we attempted to provide a balanced perspective on the current state of robotic gastrectomy, outlining evidence and opportunities for the use thereof. Although evidence is limited, the use of robotics is feasible for gastric cancer surgery, and less than 10 cases of robotic surgery are needed to become proficient therein. Compared to the clinical impact of laparoscopy on gastric cancer surgery, the additional benefits of robotic surgery to patients seem to be limited. Despite additional costs and longer surgeries, robotic surgery reportedly does not offer surgical outcomes superior to those for laparoscopic surgery, according to a recent multicenter study.Meanwhile, however, our in-depth review of retrospective and prospective reports revealed that robots could expand the indications of minimally invasive gastrectomy for patients requiring total gastrectomy and D2 lymph node dissection. Moreover, we found that robotic gastrectomy is associated with a higher number of retrieved lymph nodes, less bleeding, fewer complications, and shorter hospital stay, compared to laparoscopic gastrectomy. Accordingly, new surgical approaches using advanced technologies, such as near infrared detectors, the Tilepro ® multi-input display, dual consoles, and the Single-Site ® system, are under investigation. In conclusion, measuring the additional benefits of robotic over laparoscopic surgery would be difficult and clinically insignificant. Thus, developing new surgical procedures that extend the benefits of conventional laparoscopic surgery to patients in whom minimally invasive surgery would not be possible is necessary to justify the greater use of robotic surgery.

Similar Operative Outcomes between the da Vinci Xi® and da Vinci Si® Systems in Robotic Gastrectomy for Gastric Cancer

“…Since the introduction of robotic systems, the minimally invasive approach was further revolutionized. Robotic application facilitates technically challenging procedures, such as suturing, to be performed easily and in comfort [12]. Robotic gastrectomy has also been increasingly performed and has demonstrated satisfactory initial surgical outcomes, which are comparable to the laparoscopic approach [3456].…”

Robotic Surgery, Is It the Future?

“…Whilst laparoscopic distal gastrectomy was comparable to open distal gastrectomy in terms of short and long-term outcomes and is now considered a safe and technically feasible treatment option for early-stage gastric cancer, robotic gastric surgery did not show any tangible advantages over laparoscopic distal gastrectomy in terms of blood loss, complications or short term outcome [6]. Nevertheless, compared with open surgery, laparoscopy exhibits comparable or poorer retrieval of lymph nodes whilst robotic surgery shows comparable or better retrieval of lymph nodes than laparoscopy which means that robotic surgery may be able to address this significant weakness of traditional laparoscopy [4].…”

“…It is arguable whether all these benefits can have an impact on the work and productivity of the surgeons potentially extending their professional career by allowing them to reach expert levels earlier in their careers and to maintain high levels of precision and dexterity for longer [3]. The learning curve, particularly for trained laparoscopic surgeons, is expected to be shorter than conventional laparoscopic surgery as robots are meant to be more intuitive than laparoscopy although the curve is still lengthy and profound [4,5,8]. Virtual reality exercises have been introduced to enable surgeons to practise their robotic surgical skills, thus shortening their learning curve and that, at least in theory, could shorten the operation time, decrease complications and improve patients' safety [8].…”

“…The idea of using robots in surgery might have begun with the concept of a surgeon performing an operation at a distance without the physical existence of the surgeon who, in principle, could be in a different part of the world [1]. For practical purposes, robotic surgery should be regarded as a variant of laparoscopic surgery [4].…”

Effects of long periods of pneumoperitoneum combined with the head-up position on heart rate-corrected QT interval during robotic gastrectomy: an observational study

“… 1 Robotic gastrectomy is being increasingly regarded as an alternative minimally invasive technique that may help surgeons to overcome the principal drawbacks of laparoscopic gastrectomy. 2 – 4 Robotic-assisted systems are particularly helpful when precise dissection is required because such systems can attenuate the surgeon’s tremor, improve the surgeon’s wrist articulation, and produce three-dimensional high-resolution surgical fields. 1 , 3 …”