Robotic total gastrectomy with π-shaped esophagojejunostomy using a linear stapler as a novel technique

Abstract

ObjectiveTo evaluate the intraoperative and short-term postoperative outcomes of a novel robotic intracorporeal π-shaped esophagojejunostomy (EJS) after D2 total gastrectomy (TG) using the Da Vinci robotic surgical system for intracorporeal anastomosis after TG.BackgroundIntracorporeal π-shaped EJS, using a linear stapler, was recently reported for laparoscopic total gastrectomy in patients with gastric cancer. However, robotic intracorporeal π-shaped EJS using a linear stapler has not been reported. This report aimed to describe the use of a novel technique for π-shaped EJS using the Da Vinci robotic system.MethodsRobotic intracorporeal π-shaped esophagojejunostomy after total gastrectomy was performed in 11 consecutive patients diagnosed with early gastric cancer, and their perioperative outcomes were analyzed.ResultsAll the operations were successful without conversion to open or laparoscopic surgery and postoperative complications. The total number of patients was 11 (7 males and 4 females). The mean age of the patients was 63.36 ± 10.56 years old. Seven patients were diagnosed with cardia cancer, 3 patients were diagnosed with gastric body cancer, and 1 patient was diagnosed with gastric antrum cancer. The patients’ mean proximal resection margin was 3.18 ± 1.17 cm, the distal resection margin was 6.18 ± 1.40 cm, the mean length of the incision was 4.55 ± 0.69 cm, the mean operative time was 287.27 ± 30.69 min, the mean day of first flatus was 3.27 ± 0.79 days, the mean day of the start of diet was 2.91 ± 0.94 days, the mean postoperative hospital stay was 11.45 ± 5.13 days, and the mean operative blood loss was 47.27 ± 31.33 ml. No complications were observed during anastomosis, and the median anastomosis time was 19.5 min. The mean number of lymph node dissections was 17.91 ± 4.59, the mean number of positive lymph nodes was 0.45 ± 0.69, all patients were diagnosed with stage I–II gastric cancer, and the mean maximum diameter of the tumor was 2.67 ± 1.30 cm. All the patients had a smooth hospital discharge.ConclusionA novel robotic gastrectomy with intracorporeal π-shaped EJS for esophagojejunal anastomosis described and shows acceptable resulted. This technique has the potential to offer better short-term surgical outcomes and overcomes the drawbacks of laparoscopy with a decreased risk of complications during and after surgery.

Totally laparoscopic total gastrectomy with linear anastomosis versus laparoscopic-assisted total gastrectomy in gastric cancer：a single-center experience with meta-analysis

“…In this method, gastric resection, jejunal division and common hole closure were integrated into one procedure. The di culty of hand-sewn sutures and traction of the esophagus were solved by this method [37]. Through a retrospective analysis of 143 patients, Chen et al concluded that totally laparoscopic anastomosis with π-shaped anastomosis was safe and feasible [18].…”

Robot-assisted laparoscopic subtotal gastrectomy for early-stage gastric cancer: Case series of initial experience

“…Notably, in total gastrectomy with high BMI patients, it is necessary to perform a larger incision than a standard minilaparotomy for extracorporeal anastomosis with increasing risk due to lack of appropriate vision or excessive traction on the viscera [ [46] , [47] , [48] ]. In order to overcome these limitations, other authors proposed to carry out laparo-assisted intracorporeal anastomosis using stapler device with the Orvil [ 49 ] or the overlap technique [ 16 , 49 , 50 ]. Despite these solutions, using stapler device is associated with increasing cost of the procedure and with higher risk of leakage due to incomplete closure at the anastomotic level.…”

Risk Factors for the Severity of Complications in Minimally Invasive Total Gastrectomy for Gastric Cancer: a Retrospective Cohort Study

“…While the use of a circular stapler has generally been the standard for open total gastrectomy for decades, the standard for esophagojejunostomy has not yet been established in minimally invasive surgery. For this reason, several methods of reconstruction using linear staplers, circular staplers, and an orally inserted anvil have been reported in the literature [ 15 16 17 18 19 ]. In addition, several methods for splenic hilar dissection have also been described accordingly [ 32 52 53 54 55 ].…”

“…Among them, reconstruction of minimally invasive total gastrectomy requires a more sophisticated technique than open total gastrectomy, and it may increase the risk of anastomosis-related complications [ 11 12 13 14 ]. Therefore, previous studies that investigated potential risk factors during total gastrectomy raise particular concerns regarding anastomosis-related complications [ 15 16 17 18 19 ].…”