Technique of totally robotic delta-shaped anastomosis in distal gastrectomy

Abstract

BACKGROUND:We aimed to clarify the utility of delta-shaped anastomosis (Delta), an intracorporeal Billroth-I anastomosis-based reconstruction technique used after laparoscopy-assisted distal gastrectomy (LADG), in robot-assisted distal gastrectomy (RADG).METHODS:RADG was performed in patients with clinical Stage I gastric cancer, and reconstruction was performed using Delta. The Delta procedure was the same as that performed after LADG, and the operator practiced the procedure in simulated settings with surgical assistants before the operation. After gastrectomy, the scope and robotic first arm were reinserted from separate ports on the right side of the patient. Then, a port on the left side of the abdomen was used as the assistant port from which a stapler was inserted, with the robotic arm in a coaxial mode. The surgical assistant performed functional end-to-end anastomosis of the remnant stomach and duodenal stump using a powered stapler.RESULTS:The mean anastomotic time in four patients who underwent Delta after RADG was 16.5 min. All patients were discharged on the post-operative day 7 without any post-operative complications or need for readmission.CONCLUSIONS:Pre-operative simulation, changes in ports for insertion of the scope and robotic first arm, continuation of the coaxial operation, and use of a powered stapler made Delta applicable for RADG. Delta can be considered as a useful reconstruction method.

A technique for esophagojejunostomy following robot-assisted gastrectomy: a liner stapler and barbed suture device-based technique: a case series

“…Narrow spaces surrounded by four surgical arms interfere with the assistants’ handling of the staplers. Kitagami et al 10 reported that the robotic arms interfere with the surgical field, hence the assistant use the stapler through the space between them in delta anastomosis for robot-assisted distal gastrectomy.…”

Short- and long-term outcomes of totally robotic versus robotic-assisted radical distal gastrectomy for advanced gastric cancer: a mono-institution retrospective study

“…Only a few hospitals in mainland China have applied da Vinci robotic-assisted surgical system in use. Moreover, current literatures regarding the role of surgical robot are merely limited to novel technique [13–16] and case reports [17, 18]. The potential of da Vinci robotic-assisted surgical system in this field remains far from being fully understood.…”

Feasibility of Linear-Shaped Gastroduodenostomy during the Performance of Totally Robotic Distal Gastrectomy

“…Few studies to date have described Billroth I reconstruction during TRDG [34121314]. Linear-shaped gastroduodenostomy (LSGD), which avoids duodenal rotation and overlapping reconstruction in the anterosuperior direction, has been reported to overcome the anatomical limitations of the delta-shaped method and facilitates digestive tract reconstruction [15].…”