Clinical Study Of Da Vinci Surgical System In Gastrectomy For Gastric Cancer

Since Da Vinci surgical system was approved to use in clinical surgery by the Federal Drug Administration in2000, it has been widely used in various fields of surgery, such as cardiothoracic surgery, gynecology, pediatrics, urology, and general surgery. In the field of gastric carcinoma, the safety and feasibility of robot-assisted gastrectomy for early gastric cancer are reported. However, report of using Da Vinci surgical system in advanced gastric cancer is rare, and the views of many surgeons about its safety and clinical outcomes are different. This study therefore aimed to explore the safety, feasibility and short-term outcomes of robotic gastrectomy, through retrospectively analyzing the clinical data of patients with robotic gastrectomy, and to investigate the advantage of robot-sewn anastomosis, by comparing the clinical outcomes of anastomosis by minilaparotomy with robot-sewn anastomosis after gastrectomy.Section one:Clinical outcomes of Da Vinci surgical system assisted gastrectomy for gastric cancerObjective To investigate the safety and clinical outcomes of robotic gastrectomy for gastric cancerMethods The clinical data of167patients with gastrectomy performed by the same surgeon in general surgery department of Nanjing General Hospital of Nanjing Military Command from January2009to December2011were retrospectively analyzed. These patients were divided into two groups according to surgical technique.97patients as ROB group received robotic gastrectomy,70patients as LAP gourp received laparoscopic gastrectomy. The following parameters were compared between these two groups:intraoperative factors, clinical outcomes and lab index.Results All167operations were performed successfully without conversion and deaths. Compared with the LAP group, the ROB group had less intraoperative blood loss, more numbers of lymph node dissection, longer operation time, earlier semifluid diet time, shorter postoperative hospital stay, these above differences were statistically significant (P<0.05). There were no differences in postoperative ambulation time, ventilation time and postoperative complications (P>0.05). The patients in ROB group had lower postoperative stress response (P<0.05).Conclusions The robotic gastrectomy is safe and feasible for gastric cancer. It has many advantages such as less blood less, more numbers of lymph node dissection, quicker recovery and less influence on immunological function. Meanwhile, the same radical effect could be achieved compared to laparoscopic gastrectomy.Section two:The choices of reconstruction after robotic gastrectomy for gastric cancerObjective To investigate the safety, clinical outcomes advantage of robot-sewn anastomosis after robotic gastrectomy for gastric cancerMethods The clinical data of97patients with robotic gastrectomy for gastric cancer in general surgery department of Nanjing General Hospital of Nanjing Military Command from May2010to December2011were retrospectively analyzed. These patients were divided into two groups according to technique of reconstruction.55patients as RAG group who received robot assisted gastrectomy were reconstructed using minilaparotomy. Another42patients as TRG group who received totally robotic gastrectomy were reconstructed by robot-sewn anastomosis. The following parameters were compared between these two groups:intraoperative factors, clinical outcomes and lab index. Results All97operations were performed successfully without conversion and deaths. Compared with theRAG group, the TRG group had shorter abdominal incision, earlier ventilation time and semifluid diet time, shorter postoperative hospital stay, less hospitalization cost, these above differences were statistically significant (P<.05). There were no differences in postoperative postoperative complications (P>0.05). The patients in TRG group had lower postoperative stress response (P<0.05).Conclusions Robot-sewn anastomosis after robotic gastrectomy is safe and feasible for gastric cancer. It has many advantages such as mini-invasive, quicker recovery and smaller stress.