| Gastric cancer is the third leading causes of cancer death worldwide [1].At present,the treatment of gastric cancer is still based on the surgery.Compared with the traditional open surgery,minimally invasive surgery,such as laparoscopic and robotic surgery show benefits in terms of low complication rate,fast recovery,and less pain,and did not result in inferior 3 years of disease-free survival.Therefore,minimally invasive surgery for gastric cancer,represented by laparoscopic radical gastrectomy,has been widely applied in clinical practice.The robotic surgical system is a new minimally invasive surgical platform.Of them,the da Vinci surgical system is the most widely employed in clinical practice,provides 3D imaging with high definition,articulated movement,and elimination of physiologic tremor,which provides the basis for its application in minimally invasive surgery for gastric cancer.However,mastering and applying the robotic system requires a certain learning curve.Some studies have shown that robotic radical gastrectomy can achieve better short-term outcomes.Such as obtaining more lymph nodes,significantly reducing blood loss,postoperative complications and additional injuries,and shortening postoperative hospital stay.Meanwhile,other studies have shown that there are no significant differences from those of laparoscopic surgery.As opposed,there are also disadvantageous factors such as prolonged operative time and increased hospitalization costs.At present,there is still a lack of sufficient clinical data compared with the efficacy of laparoscopic radical gastrectomy,especially with the efficacy of 3D laparoscopic surgery.More importantly,there are few literatures that have reported the comparison between robotic surgery after overcoming the learning curve with laparoscopic radical gastrectomy.The purpose of this study was to analyze the learning curve of robotic radical distal gastrectomy and then compare the short-term outcomes with 3D laparoscopic radical gastrectomy in the same period to assess the benefit of robotic surgery system.Part one: Analyze the efficacy of robotic radical distal gastrectomyPurpose: The study’s objectives were to Analyze the efficacy of robotic radical distal gastrectomy,investigate the learning curve of robotic radical distal gastrectomy and compare the short-term outcomes of robotic radical distal gastrectomy(RDG)learning and mastery period.Methods: The cumulative sum(CUSUM)method was used to retrospectively analyze consecutive gastric cancer patients undergoing RDG in the department of gastrointestinal surgery at the Second Hospital of Dalian Medical University between January 2019 and October 2021.The duration of surgery,clinicalpathological characteristics and short-term outcomes were evaluated and according to the two phases of the learning curve(learning period versus mastery period).Results:Date from 135 RDG patients were included in this analysis.All patients completed RDG successfully without perioperative death.The CUSUM(operation time)reaches the peak when the number of surgical cases accumulates to the 20 th.The 20 cases are the minimum number of surgical cases that need to be accumulated to complete the learning curve.The learning period was 20 cases.Based on the grouping criteria of 20 patients,135 patients were divided into RDG learning period(cases 1 to 20)and mastery period(cases 21 to 135).There were no significant differences in clinicalpathological characteristics between the RDG learning period and mastery period.Compared with the learning period,the mastery period of RDG had a significant reduction in total operation time,docking time,pure operation time,and estimated blood loss,and a significant increase in hospital costs(P=0.000,0.000,0.000,0.003,and 0.026,respectively).Conclusions: The learning curve of RGD can be divided into learning period and mastery period.RGD can be mastered easily after a reasonable number of cases,and was associated with safe and satisfactory short-term outcomes before and after the learning curve.Part two: Analysis of short-term outcomes of robotic radical gastrectomy and 3D laparoscopic radical gastrectomyPurpose: The study’s objectives were to compare the short-term outcomes of robotic radical gastrectomy with laparoscopic radical gastrectomy for patients with gastric cancer including radical distal gastrectomy and radical total gastrectomy.Methods: A retrospective study was conducted to evaluate the duration of surgery,clinical-pathological characteristics and short-term outcomes from 411 patients with gastric cancer who underwent surgery in the department of gastrointestinal surgery at the Second Hospital of Dalian Medical University from January 2019 to October 2021.The clinical data were collected,and the short-term clinical efficacy of the two groups was observed.SPSS 26.0 software were used for statistic analysis.Results: Date from 411 patients were included in this analysis.All patients completed minimally invasive surgery successfully without perioperative death.Among them,115 patients underwent RDG in the mastery period,and 155 patients underwent 3D laparoscopic radical distal gastrectomy.66 patients underwent robotic radical total gastrectomy(RTG)and 55 patients underwent laparoscopic radical total gastrectomy(LTG).There were no significant differences in clinical-pathological characteristics between the RDG in the mastery period and LDG.Compared with LDG,RDG in mastery period had a longer operative time,shorter first postoperative flatus time,and more hospital costs(P=0.000,0.005,and 0.000,respectively).There were also no significant differences in clinicalpathological characteristics between the RTG and LTG.Compared with LTG,RTG had a longer total operative time,shorter first postoperative flatus time,earlier first liquid diet and more hospital costs(P=0.000,0.011,0.001 and 0.000,respectively).Conclusions: The surgical outcomes of robotic radical gastrectomy were similar to that of 3D laparoscopic surgery,it is safe and feasible and may fasten to recover gastrointestinal function faster after the operationPart three: A prospective study of the short-term outcomes of robotic radical distal gastrectomy and 3D laparoscopic radical distal gastrectomyPurpose: The study’s objectives were to compare the short-term outcomes of robotic radical distal gastrectomy with 3D laparoscopic radical distal gastrectomy by a prospective study.Methods: A prospective study was conducted to evaluate the duration of surgery,clinical-pathological characteristics and short-term outcomes from 60 patients with distal gastric cancer were compared in two groups who underwent surgery in the department of gastrointestinal surgery at the Second Hospital of Dalian Medical University from July 2022 to November 2022.The clinical data were collected,and the short-term clinical efficacy of the two groups was observed.SPSS 26.0 software were used for statistic analysis.Results: Date from 60 patients were included in this analysis.All patients completed minimally invasive surgery successfully without perioperative death.Among them,30 patients underwent RDG named RDG prospective group,and 30 patients underwent 3D LDG named LDG prospective group.There were no significant differences in clinical-pathological characteristics between the two groups.Compared with LDG prospective group,RDG prospective group had a longer total operative time,shorter first postoperative flatus time,and more hospital costs(P=0.013,0.010,and 0.045,respectively).There were also no significant differences in the total number of lymph node between the two groups however the number of No.7.8.9.11 p lymph nodes in RDG prospective group is more compared with LDG prospective group(P=0.000).There were significant differences in the subjective feelings of the surgeon wrist and waist fatigue,intraoperative vertigo,visual field angle control coordination(P=0.002,0.011,0.000and0.000).There were statistically significant differences in the subjective feelings of the first assistant in wrist fatigue,intraoperative vertigo,depth evaluation(P=0.013,0.001and0.000).Conclusions: The surgical outcomes of robotic radical gastrectomy were similar to that of 3D laparoscopic surgery,it is safe and feasible and may fasten to recover gastrointestinal function faster after the operation.Robotic surgical system can appropriately reduce the joint fatigue and vertigo of the surgeon and assistant,which can be used as one of the effective methods for the treatment of gastric cancer... |
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