Robotic Gastrectomy with Lymphadenectomy for Gastric Cancer

Abstract

The main advantages of robot technology over conventional laparoscopy include; 3-D stereoscopic vision, the ability to tremor filter and scale motions, and the internally articulated instruments that are controlled by the robotic masters that transfer the surgeon's hand movements to the tip of the instruments in an intuitive manner. All of these features enhance the surgeon's ability to perform precise fine dissection. The disadvantages of the current robotic technology include the lack of tactile feedback, and difficulty operating in multiple abdominal quadrants with heavy abdominal structures. Some of these concerns may be resolved with the newest robotic model. (DaVinci S, Intuitive Surgical Inc, Sunnyvale, CA) Table 2 lists comparative data for subtotal gastrectomies performed either laparoscopically or robotically. The largest robotic series for gastric cancer is reported by Giulianotti (Giulianotti et al., 2003). Their results are similar to those found in this report. Additionally, there are two important laparoscopic trials; one published by Lee (Lee et al., 2006) which is a large retropsective series, and the second by Huscher (Huscher et al., 2005) which is a prospective randomized trial comparing laparoscopic distal gastrectomies to open. Our robotic series compares favorable in terms of shorter hospital stays, quick return to diet, and low mortality. However, robotic operative time is longer.