J Gastric Cancer.  2012 Jun;12(2):63-72.

Robotic Gastrectomy: The Current State of the Art

• Marano A
• Hyung WJ

Abstract

Since the first laparoscopic gastrectomy for cancer was reported in 1994, minimally invasive surgery is enjoying its wide acceptance. Numerous procedures of this approach have developed, and many patients have benefited from its effectiveness, which has been recently demonstrated for early gastric cancer. However, since laparoscopic surgery is not exempt from some limitations, the robotic surgery system was introduced as a solution by the late 1990's. Many experienced surgeons have embraced this new emerging method that provides undoubted technical and minimally invasive advantages. To date, several studies have concentrated to this new system, and have compared it with open and laparoscopic approach. Most of them have reported satisfactory results concerning the post-operative short-term outcomes, but almost all believe that the role of robotic gastrectomy is still out of focus, especially because long-term outcomes that can prove robotic oncologic equivalency are lacking, and operative costs and time are higher in comparison to the open and laparoscopic ones. This article is a review about the current status of robotic surgery for the treatment of gastric cancer, especially, focusing on the technical aspects, comparisons to other approaches and future prospects.

Keyword

Stomach neoplasms; Robotic surgery; Laparoscopy

MeSH Terms

Gastrectomy
Humans
Laparoscopy
Stomach Neoplasms

Reference

1. Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N. Japanese Laparoscopic Surgery Study Group. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg. 2007. 245:68–72.

2. Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg. 2005. 241:232–237.

3. Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report--a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg. 2010. 251:417–420.

4. Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, et al. Robotics in general surgery: personal experience in a large community hospital. Arch Surg. 2003. 138:777–784.

5. Hyung WJ. Robotic surgery in gastrointestinal surgery. Korean J Gastroenterol. 2007. 50:256–259.

6. Baek SJ, Lee DW, Park SS, Kim SH. Current status of robot-assisted gastric surgery. World J Gastrointest Oncol. 2011. 3:137–143.

7. Buchs NC, Bucher P, Pugin F, Morel P. Robot-assisted gastrectomy for cancer. Minerva Gastroenterol Dietol. 2011. 57:33–42.

8. Hashizume M, Sugimachi K. Robot-assisted gastric surgery. Surg Clin North Am. 2003. 83:1429–1444.

9. Song J, Oh SJ, Kang WH, Hyung WJ, Choi SH, Noh SH. Robot-assisted gastrectomy with lymph node dissection for gastric cancer: lessons learned from an initial 100 consecutive procedures. Ann Surg. 2009. 249:927–932.

10. Hyung WJ, Woo YH, Noh SH. Robotic surgery for gastric cancer: a technical review. J Robot Surg. 2011. 5:241–249.

11. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011. 14:101–112.

12. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011. 14:113–123.

13. D'Annibale A, Pende V, Pernazza G, Monsellato I, Mazzocchi P, Lucandri G, et al. Full robotic gastrectomy with extended (D2) lymphadenectomy for gastric cancer: surgical technique and preliminary results. J Surg Res. 2011. 166:e113–e120.

14. Song J, Kang WH, Oh SJ, Hyung WJ, Choi SH, Noh SH. Role of robotic gastrectomy using da Vinci system compared with laparoscopic gastrectomy: initial experience of 20 consecutive cases. Surg Endosc. 2009. 23:1204–1211.

15. Patriti A, Ceccarelli G, Bellochi R, Bartoli A, Spaziani A, Di Zitti L, et al. Robot-assisted laparoscopic total and partial gastric resection with D2 lymph node dissection for adenocarcinoma. Surg Endosc. 2008. 22:2753–2760.

16. Anderson C, Ellenhorn J, Hellan M, Pigazzi A. Pilot series of robot-assisted laparoscopic subtotal gastrectomy with extended lymphadenectomy for gastric cancer. Surg Endosc. 2007. 21:1662–1666.

17. Isogaki J, Haruta S, Man-I M, Suda K, Kawamura Y, Yoshimura F, et al. Robot-assisted surgery for gastric cancer: experience at our institute. Pathobiology. 2011. 78:328–333.

18. Hyung WJ, Song C, Cheong JH, Choi SH, Noh SH. Percutaneous needle decompression during laparoscopic gastric surgery: a simple alternative to nasogastric decompression. Yonsei Med J. 2005. 46:648–651.

19. Woo Y, Hyung WJ, Kim HI, Obama K, Son T, Noh SH. Minimizing hepatic trauma with a novel liver retraction method: a simple liver suspension using gauze suture. Surg Endosc. 2011. 25:3939–3945.

20. Shinohara T, Kanaya S, Yoshimura F, Hiramatsu Y, Haruta S, Kawamura Y, et al. A protective technique for retraction of the liver during laparoscopic gastrectomy for gastric adenocarcinoma: using a Penrose drain. J Gastrointest Surg. 2011. 15:1043–1048.

21. Shabbir A, Lee JH, Lee MS, Park do J, Kim HH. Combined suture retraction of the falciform ligament and the left lobe of the liver during laparoscopic total gastrectomy. Surg Endosc. 2010. 24:3237–3240.

22. Hyung WJ, Lim JS, Cheong JH, Kim J, Choi SH, Song SY, et al. Intraoperative tumor localization using laparoscopic ultrasonography in laparoscopic-assisted gastrectomy. Surg Endosc. 2005. 19:1353–1357.

23. Kim HI, Hyung WJ, Lee CR, Lim JS, An JY, Cheong JH, et al. Intraoperative portable abdominal radiograph for tumor localization: a simple and accurate method for laparoscopic gastrectomy. Surg Endosc. 2011. 25:958–963.

24. Pugliese R, Maggioni D, Sansonna F, Ferrari GC, Forgione A, Costanzi A, et al. Outcomes and survival after laparoscopic gastrectomy for adenocarcinoma. Analysis on 65 patients operated on by conventional or robot-assisted minimal access procedures. Eur J Surg Oncol. 2009. 35:281–288.

25. Pugliese R, Maggioni D, Sansonna F, Costanzi A, Ferrari GC, Di Lernia S, et al. Subtotal gastrectomy with D2 dissection by minimally invasive surgery for distal adenocarcinoma of the stomach: results and 5-year survival. Surg Endosc. 2010. 24:2594–2602.

26. Kim MC, Heo GU, Jung GJ. Robotic gastrectomy for gastric cancer: surgical techniques and clinical merits. Surg Endosc. 2010. 24:610–615.

27. Hur H, Kim JY, Cho YK, Han SU. Technical feasibility of robot-sewn anastomosis in robotic surgery for gastric cancer. J Laparoendosc Adv Surg Tech A. 2010. 20:693–697.

28. Uyama I, Kanaya S, Ishida Y, Inaba K, Suda K, Satoh S. Novel integrated robotic approach for suprapancreatic D2 nodal dissection for treating gastric cancer: technique and initial experience. World J Surg. 2012. 36:331–337.

29. Liu FL, Lv CT, Qin J, Shen KT, Chen WD, Shen ZB, et al. Da Vinci robot-assisted gastrectomy with lymph node dissection for gastric cancer: a case series of 9 patients. Zhonghua Wei Chang Wai Ke Za Zhi. 2010. 13:327–329.

30. Lee HH, Hur H, Jung H, Jeon HM, Park CH, Song KY. Robot-assisted distal gastrectomy for gastric cancer: initial experience. Am J Surg. 2011. 201:841–845.

31. Yu PW, Tang B, Zeng DZ, Zhao YL, Shi Y, Hao YX, et al. Robotic-assisted radical gastrectomy using da Vinci robotic system: a report of 41 cases. Zhonghua Wei Chang Wai Ke Za Zhi. 2012. 15:121–124.

32. Caruso S, Patriti A, Marrelli D, Ceccarelli G, Ceribelli C, Roviello F, et al. Open vs robot-assisted laparoscopic gastric resection with D2 lymph node dissection for adenocarcinoma: a case-control study. Int J Med Robot. 2011. 7:452–458.

33. Glantzounis G, Ziogas D, Baltogiannis G. Open versus laparoscopic versus robotic gastrectomy for cancer: need for comparative-effectiveness quality. Surg Endosc. 2010. 24:1510–1512.

34. Pernazza G, Gentile E, Felicioni L, Tumbiolo S, Giulianotti PC. Improved early survival after robotic gastrectomy in advanced gastric cancer. Surg Laparosc Endosc Percutan Tech. 2006. 16:286.

35. Eom BW, Yoon HM, Ryu KW, Lee JH, Cho SJ, Lee JY, et al. Comparison of surgical performance and short-term clinical outcomes between laparoscopic and robotic surgery in distal gastric cancer. Eur J Surg Oncol. 2012. 38:57–63.

36. Woo Y, Hyung WJ, Pak KH, Inaba K, Obama K, Choi SH, et al. Robotic gastrectomy as an oncologically sound alternative to laparoscopic resections for the treatment of early-stage gastric cancers. Arch Surg. 2011. 146:1086–1092.

37. Yoon HM, Kim YW, Lee JH, Ryu KW, Eom BW, Park JY, et al. Robot-assisted total gastrectomy is comparable with laparoscopically assisted total gastrectomy for early gastric cancer. Surg Endosc. 2012. 26:1377–1381.

38. Huang KH, Lan YT, Fang WL, Chen JH, Lo SS, Hsieh MC, et al. Initial experience of robotic gastrectomy and comparison with open and laparoscopic gastrectomy for gastric cancer. J Gastrointest Surg. 2012. [Epub ahead of print].

39. Jayaraman S, Quan D, Al-Ghamdi I, El-Deen F, Schlachta CM. Does robotic assistance improve efficiency in performing complex minimally invasive surgical procedures? Surg Endosc. 2010. 24:584–588.

40. Heemskerk J, van Gemert WG, de Vries J, Greve J, Bouvy ND. Learning curves of robot-assisted laparoscopic surgery compared with conventional laparoscopic surgery: an experimental study evaluating skill acquisition of robot-assisted laparoscopic tasks compared with conventional laparoscopic tasks in inexperienced users. Surg Laparosc Endosc Percutan Tech. 2007. 17:171–174.