| Objective: The safety and feasibility of full robotic radical gastrectomy with intracorporeal Billroth Ⅰ manual suture were investigated by comparing the perioperative conditions and postoperative efficacy of patients who received robotic radical gastrectomy with those who received laparoscopic radical gastrectomy with intracorporeal Billroth Ⅰ manual suture.Methods: A retrospective analysis was performed on the clinical data of 87 patients who underwent distal gastrectomy and total intracorporeal Billroth Ⅰ manual suture for distal gastric cancer in the Department of Gastrointestinal Surgery of the Second Hospital of Dalian Medical University from January 2019 to September 2022.The patients were divided into the robot group(39 cases,45%)and the laparoscopic group(48 cases,55%),and the perioperative indexes and long-term tumor outcomes of the two groups were compared.Follow-up was up until December 2022.SPSS 26.0statistical software was used to analyze the data;Chi-square test or Fisher’s exact test was used for categorical variables;t test or rank sum test was used for numerical variables and ordered categorical variables;three-year overall survival rate was used Kaplan-Meier method and survival curve was drawn;comparison between the two groups was conducted by log-rank test.P<0.05 indicates a significant difference.Results: All patients in the two groups successfully completed the operation,no conversion to open case,no second operation,no perioperative death.There was no significant difference in age,gender and other general information between the two groups(P>0.05).The total operation time of the robotic group and the laparoscopic group was 170(148～190)min and 140(130～170)min,respectively.The loading time of robot group and laparoscopic group was 30(28～32)min and 4(3～5)min,respectively.VAS scores 12 hours after surgery were 2.0(1.0-3.0)in the robotic group and 3.0(2.0-3.0)in the laparoscopic group,respectively.The hospitalization expenses of the robot group and the laparoscopic group were 85560.71(95057.64～108277.66)yuan and 70404.11(64825.22～84793.30)yuan,respectively.There are significant differences in the above data(P<0.05),the total operation time was deducted from the preoperative preparation time to obtain the actual operation time,which was basically the same(P>0.05).Postoperative pathological specimens of both groups were negative,and the number of lymph nodes dissection and intraoperative blood loss were not statistically significant(P>0.05).The postoperative recovery speed of the two groups was basically the same(P>0.05).Delayed gastric emptying occurred in 4 cases(10.0%)in the robotic group and in 3 cases(6.3%)in the laparoscopic group,showing no significant difference compared with the laparoscopic group(P=0.082).Other complications,such as delayed incision healing and Clavien-Dindo complication grading,showed no significant difference(P>0.05).The median follow-up time was 36(20-41)months,and the long-term efficacy of the two groups was basically the same(P>0.05).Conclusion: Intracorporeal BillrothⅠ manual suture in full robotic gastrectomy is safe and feasible.It can be used for digestive tract reconstruction after distal gastrectomy.There was no significant difference in short-term efficacy,such as preoperative baseline data,tumor radical index,postoperative rehabilitation,complication rate,and long-term efficacy between the robot group and the traditional 3D laparoscopic group.The robotic group was better than the laparoscopic group in postoperative pain,and the robotic surgical system had certain advantages in manual suture.However,robotic surgery is more expensive and requires longer preoperative preparation time. |
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