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Chicago 2009 Video – Robot Assisted Gastrectomy D2 Dissection for Adenocarcinoma: Initial Experience with 20 Patient

Chicago 2009 Video – Robot Assisted Gastrectomy D2 Dissection for Adenocarcinoma: Initial Experience with 20 Patient

M. Gualtierotti

Background
The aims of this study were to assess the feasibility of robot–assisted gastrectomy for adenocarcinoma with D2 lymph nodal dissection and to analyze our preliminary results.

Patients and methods
Between January 2006 and June 2009 as many as 20 patients (12 females, 8 males) underwent laparoscopic robot assisted surgery for non metastatic adenocarcinoma of the stomach by a 3-armed da Vinci ® Robotic Surgical System. This series included 10 patients with early gastric cancer (EGC) and 10 with advanced gastric cancer (AGC). A 4/5 laparoscopic subtotal gastrectomy with D2 nodal clearance was the procedure of choice for 17 distal cancers. Laparoscopic total gastrectomy with D2 lymphadenectomy was performed for 3 cancers of the middle third of the stomach.

Results
No intraoperative complication was registered. Conversion to laparotomy was required in 2 patients. The mean operating time (excluding converted patients) was 352 minutes. Morbidity occurred in 4 patients. One death occurred postoperatively for haemorragic stroke. On average, 28 lymph nodes were collected. The resection margin was 6.4cm and the margin was tumor free in all the specimens. The mean hospital stay was 11 days (range 7-38). The mean follow up was 15 months (range 1-30), 3 patients with AGC showed recurrence and died for disease.

Conclusions
Robotics in gastrectomy for cancer is a feasible and safe procedure, yielding adequate D2 nodal clearance with respect of oncologic principles. Robotic surgery, thanks to three-dimensional view, Endowrist instruments , tremor filter, motion scaling and ergonomic position, improves the surgeon’s dexterity in technical demanding procedures like D2 dissection. This fact makes minimally invasive surgery more accessible to patients with the advantages related.

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