REVIEW  APPLICATIONS OF ROBOTICS IN GENERAL SURGERY 

Minerva Surgery 2021 April;76(2):116-23

DOI: 10.23736/S2724-5691.21.08769-1

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Robotic gastric surgery: a monocentric case series and review of the literature

Fabio STADERINI ¹ ✉, Francesco GIUDICI ¹, Francesco CORATTI ¹, Damiano BISOGNI ², Francesca CAMMELLI ¹, Giuseppe BARBATO ¹, Chiara GATTO ¹, Federico MANETTI ¹, Giovanni Braccini ¹, Fabio CIANCHI ¹

¹ Center of Oncological Minimally Invasive Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; ² Interventional Endoscopy, Department of Oncology and Robotic Surgery, Careggi University Hospital, Florence, Italy

INTRODUCTION: The technical complexity of D2 lymphadenectomy and esophago-jejunal anastomosis are the main factors that limit the application of laparoscopic surgery in the treatment of gastric cancer. Robotic assisted gastric surgery provides potential technical advantages over conventional laparoscopy but an improvement in clinical outcomes after robotic surgery has not been demonstrated yet.
EVIDENCE ACQUISITION: Data from 128 consecutive patients who had undergone robotic gastrectomy for gastric cancer at our center institution from April 2017 to June 2020 where retrospectively reviewed from a prospectively updated database. A narrative review was then carried out on PubMed, Embase and Scopus using the following keywords: “gastric cancer,” “robotic surgery,” “robotic gastrectomy” and “robotic gastric surgery”.
EVIDENCE SYNTHESIS: Ninety-eight patients underwent robotic distal gastrectomy and 30 underwent robotic total gastrectomy. The mean value of estimated blood loss was 99.5 ml. No patients required conversion to laparoscopy or open surgery. The median number of retrieved lymph nodes was 42. No tumor involvement of the proximal or distal margin was found in any patient. The median time to first flatus and first oral feeding was on postoperative day 3 and 5, respectively. We registered 6 leakages (4.6%), namely, 1 duodenal stump leakage and 5 anastomotic leakages. No 30-day surgical related mortality was recorded. The median length of hospital stay was 10.5 days (range 4-37).
CONCLUSIONS: Published data and our experience suggest that the robotic approach for gastric cancer is safe and feasible with potential advantages over conventional laparoscopy.

KEY WORDS: Gastrectomy; Minimally invasive surgery; Robotics; Stomach neoplasms