The integration of the intracorporeal triangular anastomotic technique in robotic distal gastrectomy: advancing patient safety and procedural simplicity.
Billroth I reconstruction
Distal gastrectomy
Gastric cancer
Robotic surgery
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
12 Aug 2024
12 Aug 2024
Historique:
received:
14
05
2024
accepted:
05
08
2024
medline:
13
8
2024
pubmed:
13
8
2024
entrez:
12
8
2024
Statut:
aheadofprint
Résumé
Robotic distal gastrectomy (RDG) with Billroth I (BI) reconstruction is predominantly performed due to its physiological congruence and simplicity. The Intracorporeal Triangular Anastomotic Technique (INTACT) aims to reduce ischemic areas compared to the conventional Delta-shaped anastomosis using the unique characteristics of robotic surgery to standardize procedures, thereby ensuring safe, simple, and reliable reconstruction. This study aims to investigate the efficacy of the INTACT in RDG with BI reconstruction, focusing on its robotic precision in minimizing ischemic zones and improving surgical reliability. The posterior duodenal wall is dissected before reconstruction, and the hepatoduodenal ligament is severed to facilitate passive duodenal manipulation. A quarter-circumference incision is created centrally on the anterior wall of the duodenal stump to avoid excessive tension during anastomosis and to ensure an adequate anastomotic diameter. A small opening is established on the greater curvature of the remaining stomach, and the posterior walls of the stomach and duodenum are joined using a Linear stapler in the first fire. A V-shape is created, and two EndoWrist instruments (robotic first and fourth arms) are utilized to grip and extend the anastomosis diameter, completing the anastomosis with a shared hole closure using the Linear stapler. The robotic arms' features improve the physiological integrity and stability of the BI reconstruction. A total of 81 patients underwent RDG with INTACT from September 2020 to January 2024. The median age was 72 years (range: 31-91), with 49 males and 32 females. The median blood loss was 0 ml (range: 0-200 ml), and the median postoperative hospital stay was 8 days (range: 6-20 days). No cases required reanastomosis during surgery, and no postoperative anastomotic leakage, surgery-related reoperations, or anastomotic strictures were reported. INTACT in RDG can be safely performed. The characteristics of the EndoWrist instruments helped in stabilizing the technique, making it a viable option in robotic-assisted surgeries.
Sections du résumé
BACKGROUND
BACKGROUND
Robotic distal gastrectomy (RDG) with Billroth I (BI) reconstruction is predominantly performed due to its physiological congruence and simplicity. The Intracorporeal Triangular Anastomotic Technique (INTACT) aims to reduce ischemic areas compared to the conventional Delta-shaped anastomosis using the unique characteristics of robotic surgery to standardize procedures, thereby ensuring safe, simple, and reliable reconstruction. This study aims to investigate the efficacy of the INTACT in RDG with BI reconstruction, focusing on its robotic precision in minimizing ischemic zones and improving surgical reliability.
SURGICAL TECHNIQUE
METHODS
The posterior duodenal wall is dissected before reconstruction, and the hepatoduodenal ligament is severed to facilitate passive duodenal manipulation. A quarter-circumference incision is created centrally on the anterior wall of the duodenal stump to avoid excessive tension during anastomosis and to ensure an adequate anastomotic diameter. A small opening is established on the greater curvature of the remaining stomach, and the posterior walls of the stomach and duodenum are joined using a Linear stapler in the first fire. A V-shape is created, and two EndoWrist instruments (robotic first and fourth arms) are utilized to grip and extend the anastomosis diameter, completing the anastomosis with a shared hole closure using the Linear stapler. The robotic arms' features improve the physiological integrity and stability of the BI reconstruction.
RESULTS
RESULTS
A total of 81 patients underwent RDG with INTACT from September 2020 to January 2024. The median age was 72 years (range: 31-91), with 49 males and 32 females. The median blood loss was 0 ml (range: 0-200 ml), and the median postoperative hospital stay was 8 days (range: 6-20 days). No cases required reanastomosis during surgery, and no postoperative anastomotic leakage, surgery-related reoperations, or anastomotic strictures were reported.
CONCLUSION
CONCLUSIONS
INTACT in RDG can be safely performed. The characteristics of the EndoWrist instruments helped in stabilizing the technique, making it a viable option in robotic-assisted surgeries.
Identifiants
pubmed: 39134717
doi: 10.1007/s00464-024-11171-5
pii: 10.1007/s00464-024-11171-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Sakaguchi M, Hosogi H, Tokoro Y, Yagi D, Shimoike N, Akagawa S, Kanaya S (2021) Functional outcomes of delta-shaped anastomosis after laparoscopic distal gastrectomy. J Gastrointest Surg Off J Soc Surg Aliment Tract 25(2):397–404
doi: 10.1007/s11605-020-04516-7
Sah BK, Chen MM, Yan M, Zhu ZG (2009) Gastric cancer surgery: Billroth I or Billroth II for distal gastrectomy? BMC Cancer 9:428
doi: 10.1186/1471-2407-9-428
pubmed: 20003202
pmcid: 2794879
Kitagami H, Morimoto M, Nozawa M, Nakamura K, Tanimura S, Murakawa K, Murakami Y, Kikuchi K, Ushigome H, Sato L et al (2014) Evaluation of the delta-shaped anastomosis in laparoscopic distal gastrectomy: midterm results of a comparison with Roux-en-Y anastomosis. Surg Endosc 28(7):2137–2144
doi: 10.1007/s00464-014-3445-6
pubmed: 24515263
pmcid: 4065338
Ojima T, Nakamura M, Yamaue H (2020) Full robotic Roux-en-Y reconstruction after gastrectomy for gastric cancer: a loop reconstruction technique. Updates Surg 72(4):1279–1281
doi: 10.1007/s13304-020-00889-1
pubmed: 32930976
Ojima T, Nakamura M, Hayata K, Yamaue H (2020) Laparoscopic Roux-en-Y reconstruction using conventional linear stapler in robotic total gastrectomy for gastric cancer. Surg Oncol 33:9–10
doi: 10.1016/j.suronc.2019.12.003
pubmed: 31885361
Uyama I, Kanaya S, Ishida Y, Inaba K, Suda K, Satoh S (2012) Novel integrated robotic approach for suprapancreatic D2 nodal dissection for treating gastric cancer: technique and initial experience. World J Surg 36(2):331–337
doi: 10.1007/s00268-011-1352-8
pubmed: 22131088
Obama K, Sakai Y (2016) Current status of robotic gastrectomy for gastric cancer. Surg Today 46(5):528–534
doi: 10.1007/s00595-015-1190-7
pubmed: 26019020
Ushimaru Y, Nagano S, Kawabata R, Nishikawa K, Takeoka T, Kitagawa A, Ohara N, Tomihara H, Maeda S, Imasato M et al (2024) Enhancing surgical outcomes in elderly gastric cancer patients: the role of comprehensive preoperative assessment and support. World J Surg Oncol 22(1):136
doi: 10.1186/s12957-024-03421-6
pubmed: 38778314
pmcid: 11112811
Yanagimoto Y, Omori T, Fujiwara Y, Demura K, Jeong-Ho M, Shinno N, Yamamoto K, Sugimura K, Miyata H, Ushigome H et al (2020) Comparison of the intracorporeal triangular and delta-shaped anastomotic techniques in totally laparoscopic distal gastrectomy for gastric cancer: an analysis with propensity score matching. Surg Endosc 34(6):2445–2453
doi: 10.1007/s00464-019-07025-0
pubmed: 31385072
Omori T, Masuzawa T, Akamatsu H, Nishida T (2014) A simple and safe method for Billroth I reconstruction in single-incision laparoscopic gastrectomy using a novel intracorporeal triangular anastomotic technique. J Gastrointest Surg Off J Soc Surg Aliment Tract 18(3):613–616
doi: 10.1007/s11605-013-2419-7
Hu GY, Tao F, Ji KW, Wang W (2016) Comparison of delta-shape anastomosis and extracorporeal Billroth I anastomosis after laparoscopic distal gastrectomy for gastric cancer: a systematic review with meta-analysis of short-term outcomes. PLoS ONE 11(9):e0162720
doi: 10.1371/journal.pone.0162720
pubmed: 27631378
pmcid: 5025198
Ushimaru Y, Nagano S, Nishikawa K, Kawabata R, Takeoka T, Kitagawa A, Ohara N, Tomihara H, Maeda S, Imazato M et al (2024) A comprehensive study on non-cancer-related mortality risk factors in elderly gastric cancer patients post-curative surgery. BMC Gastroenterol 24(1):78
doi: 10.1186/s12876-024-03170-6
pubmed: 38373885
pmcid: 10875761
Kanaya S, Gomi T, Momoi H, Tamaki N, Isobe H, Katayama T, Wada Y, Ohtoshi M (2002) Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: new technique of intraabdominal gastroduodenostomy. J Am Coll Surg 195(2):284–287
doi: 10.1016/S1072-7515(02)01239-5
pubmed: 12168979
Kanaya S, Kawamura Y, Kawada H, Iwasaki H, Gomi T, Satoh S, Uyama I (2011) The delta-shaped anastomosis in laparoscopic distal gastrectomy: analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy. Gastric Cancer 14(4):365–371
doi: 10.1007/s10120-011-0054-0
pubmed: 21573920
Suda K, Yamamoto H, Nishigori T, Obama K, Yoda Y, Hikage M, Shibasaki S, Tanaka T, Kakeji Y, Inomata M et al (2022) Safe implementation of robotic gastrectomy for gastric cancer under the requirements for universal health insurance coverage: a retrospective cohort study using a nationwide registry database in Japan. Gastric Cancer 25(2):438–449
doi: 10.1007/s10120-021-01257-7
pubmed: 34637042
Shibasaki S, Suda K, Hisamori S, Obama K, Terashima M, Uyama I (2023) Robotic gastrectomy for gastric cancer: systematic review and future directions. Gastric Cancer 26(3):325–338
doi: 10.1007/s10120-023-01389-y
pubmed: 37010634
Ojima T, Nakamura M, Hayata K, Kitadani J, Katsuda M, Takeuchi A, Tominaga S, Nakai T, Nakamori M, Ohi M et al (2021) Short-term outcomes of robotic gastrectomy vs. laparoscopic gastrectomy for patients with gastric cancer: a randomized clinical trial. JAMA Surg 156(10):954–963
doi: 10.1001/jamasurg.2021.3182
pubmed: 34468701
Ojima T, Nakamura M, Hayata K, Nakamori M, Kitadani J, Katsuda M, Fukuda N, Yamaue H (2019) Laparoscopic Billroth I gastroduodenostomy in robotic distal gastrectomy for gastric cancers: fusion surgery. Surg Laparosc Endosc Percutan Tech 29(6):520–523
doi: 10.1097/SLE.0000000000000720
pubmed: 31517746