Robotically-enhanced surgical anatomy enables surgeons to perform distal gastrectomy for gastric cancer using electric cautery devices alone

Despite recent advances in robotic urological surgery, the feasibility and clinical merit of robotic gastric surgery have not yet been fully documented. Therefore, we designed a prospective, non-randomized study to determine the feasibility and safety of robot-assisted distal gastrectomy (RADG) for gastric cancer using electric cautery devices, which are more familiar to open surgery. Between April 2010 and December 2012, 181 patients treated by distal gastrectomy for gastric carcinoma were eligible for this study. According to their intent to undergo uninsured robotic surgery, 21 patients were treated with RADG (RADG group) while 160 patients were treated by conventional laparoscopic distal gastrectomy (LDG group). Under a basic working hypothesis that the superior visualization and unique movement of the robotic arms during dissection would be closely associated with reduced amount of blood loss, even though an equivalent extension of lymph node dissection was carried out, we prospectively collected data from patients in the RADG and LDG groups. All patients were successfully treated without conversion except for one patient in the RADG group who underwent conversion to laparoscopic total gastrectomy. In comparison with the patient groups, the estimated blood loss in patients in the RADG group treated with electric cautery devices only was smaller, but not significantly, than patients in the LDG group treated with ultrasonic-activated devices, although the same extent of lymph node dissection was achieved. In contrast, there were four patients (2.5 %) in the LDG group who developed a pancreas fistula or intra-abdominal abscess, while no patients treated with RADG developed such complications. RADG using electric cautery instruments without ultrasonic-activated devices is feasible and safe. The robot enables particular surgical views, called robotically-enhanced surgical anatomy, and may contribute to reducing blood loss despite the fact that only electric cautery was used.