Robotic surgery for gastric cancer: expert opinion from a western perspective

Gastric surgery is one of the most relevant felds of development for minimally invasive technologies. Laparoscopy is now widespread, and several studies have demonstrated its feasibility and safety even in some advanced oncological procedures. Robotic surgery has several intrinsic advantages that theoretically can improve an extensive lymphadenectomy or the reconstruction phase.Much remains to be addressed in this field and further studies are necessary to offer the patient the best possible approach based on his characteristics and the stage of his disease.The present report off ers an overview on robotics and its role in gastric surgery

Reconstruction methods during laparoscopic gastrectomy

Gastric surgery is one of the most relevant fi elds of development for minimally invasive technologies. Laparoscopy is now widespread, and several studies have demonstrated its feasibility and safety even in some advanced oncological procedures. Robotic surgery has several intrinsic advantages that theoretically can improve an extensive lymphadenectomy or the reconstruction phase.Much remains to be addressed in this field and further studies are necessary to offer the patient the best possible approach based on his characteristics and the stage of his disease.The present report off ers an overview on robotics and its role in gastric surgery

Robotic surgery for gastric cancer: a review of the literature

Minimally invasive surgery is increasing attention worldwide as an effective treatment approach in gastric cancer.In this context, several studies suggest that robotic technology may add some advantages over traditional laparoscopy, but the role of the robotic approach in the common surgical setting is still uncertain.The objective of this study is to review the current evidences in the literature comparing robotic surgery to other surgical approaches.Patients underwent robotic gastrectomy showed some benefits in terms of blood loss, postoperative morbidity, and length of hospital stay. No significant differences have been found in terms of survivals, while the number of lymph nodes retrieved with therobotic approach, expecially in the extraperigastric region, is generally higher than that of laparoscopy.The current studies in the literature suggest that the robotic gastrectomy is not inferior to the laparoscopic procedure and provides some surgical and clinical benefits

Enhanced recovery after surgery for gastric cancer (ERAS-GC). Optimizing patient outcome

Significant advances were achieved, in last decades, in the management of surgical patients with gastric cancer. This has led to the concept of enhanced recovery after surgery (ERAS) with the objective of reducing the length of hospital stay, accelerating postoperative recovery and reducing the surgical stress. The ERAS protocols have many items, including the pre-operative patient education, early mobilization and feeding starting from the first postoperative day. This review aims to highlight possible advantages on postoperative functional recovery outcomes after gastrectomy in patients undergoing an ERAS program, current lack of evidences and future perspectives

Robotic double-loop reconstruction method following total gastrectomy

Minimally invasive surgery for gastric cancer is a challenge. The reconstructive time is a particular issue and researchers have adopted a large variety of solutions and produced heterogeneous data. The reconstructive phase can be divided into two major categories based on the approach adopted: the execution of extracorporeal versus intracorporeal anastomosis. In turn, the surgical team can perform the latter with laparoscopic or robotic assistance. However, the question is, how should a robotic esophagojejunal anastomosis be performed after total gastrectomy? Most articles in the literature have reported the execution of mechanical anastomoses [1] [2] [3] [4] [5] [6], especially with circular staplers via the creation of a manual purse-string around the anvil. Other solutions have described the use of the Orvil or the overlap technique. Only three authors have reported intracorporeal sutures with a completely robotic-sewn anastomosis [7] [8] [9]. A new robotic technique (the Parisi technique) was developed and adopted at St. Mary’s Hospital, Terni, Italy. A double-loop reconstruction method with an intracorporeal robot-sewn anastomosis is performe

New totally intracorporeal reconstructive approach after robotic total gastrectomy. Technical details and short-term outcomes

AIM: To show outcomes of our series of patients that underwent a total gastrectomy with a robotic approach and highlight the technical details of a proposed solution for the reconstruction phase. METHODS: Data of gastrectomies performed from May 2014 to October 2016, were extracted and analyzed. Basic characteristics of patients, surgical and clinical outcomes were reported. The technique for reconstruction (Parisi Technique) consists on a loop of bowel shifted up antecolic to directly perform the esophago-enteric anastomosis followed by a second loop, measured up to 40 cm starting from the esojejunostomy, fixed to the biliary limb to create an enteroenteric anastomosis. The continuity between the two anastomoses is interrupted just firing a linear stapler, so obtaining the Roux-en-Y by avoiding to interrupt the mesentery. RESULTS: Fifty-five patients were considered in the present analysis. Estimated blood loss was 126.55 ± 73 mL, no conversions to open surgery occurred, R0 resections were obtained in all cases. Hospital stay was 5 (3-17) d, no anastomotic leakage occurred. Overall, a fast functional recovery was shown with a median of 3 (3-6) d in starting a solid diet. CONCLUSION: Robotic surgery and the adoption of a tailored reconstruction technique have increased the feasibility and safety of a minimally invasive approach for total gastrectomy. The present series of patients shows its implementation in a western center with satisfying short-term outcomes

Fluorescence image-guided lymphadenectomy using indocyanine green and near infrared technology during robotic gastrectomy: a prospective pilot study: IG-MIG Study

Background:Gastric cancer is a worldwide challenge due to its spread, even epidemic in some areas, and the high mortality rates. Lymphadenectomy is considered the fundamental step during radical gastrectomy. In recent years, some researchers have tried to find a way to improve the surgical identifi cation of the lymphatic drainage routes and lymph node stations. This new surgical frontier is the so called “navigation surgery”. Among the diff erent reported solutions, lately, the indocyanine green (ICG) has drawn attention. It is a fluorescence dye, that can be detected in the near infrared spectral band (NIR).The development of specific fluorescence imaging devices has allowed surgeons to visualize tumors, vascular and lymphatic structures. The Da Vinci Xi robotic system has an integrated imaging technology that has been used in colo-rectal and hepatobiliary surgery. However, up to date, the combined use of fluorescence imaging and robotic technology has not been evaluated during lymphadenectomy in gastric cancer.Methods:General design: to evaluate the role of fluorescence imaging during robotic lymphadenectomy for gastric cancer.Type of study: interventional prospective pilot study.Duration: 18 months.Experimental group: patients undergoing dissection assisted by ICG.Control group: patients undergoing the same surgery without the injection of ICG.Primary outcomes: Fluorescent lymph nodes (FLNs) identification rate, accuracy of the procedure, comparison with the control group on the total number of lymph nodes retrieved.Sample size: 20 patients in the experimental group, 20 patients in the control group.Ethics:This study is conducted in compliance with ethical principles originating from the Helsinki Declaration, within the guidelines of Good Clinical Practice and relevant laws/regulations.Trial registration number:NCT0393104

Laparoscopic peritoneal lavage. Our experience and review of the literature

NTRODUCTION: Over the years various therapeutic techniques for diverticulitis have been developed. Laparoscopic peritoneal lavage (LPL) appears to be a safe and useful treatment, and it could be an effective alternative to colonic resection in emergency surgery. AIM: This prospective observational study aims to assess the safety and benefits of laparoscopic peritoneal lavage in perforated sigmoid diverticulitis. MATERIAL AND METHODS: We surgically treated 70 patients urgently for complicated sigmoid diverticulitis. Thirty-two (45.7%) patients underwent resection of the sigmoid colon and creation of a colostomy (Hartmann technique); 21 (30%) patients underwent peritoneal laparoscopic lavage; 4 (5.7%) patients underwent colostomy by the Mikulicz technique; and the remaining 13 (18.6%) patients underwent resection of the sigmoid colon and creation of a colorectal anastomosis with a protective ileostomy. RESULTS: The 66 patients examined were divided into 3 groups: 32 patients were treated with urgent surgery according to the Hartmann procedure; 13 patients were treated with resection and colorectal anastomosis; 21 patients were treated urgently with laparoscopic peritoneal lavage. We had no intraoperative complications. The overall mortality was 4.3% (3 patients). In the LPL group the morbidity rate was 33.3%. CONCLUSIONS: Currently it cannot be said that LPL is better in terms of mortality and morbidity than colonic resection. These data may, however, be proven wrong by greater attention in the selection of patients to undergo laparoscopic peritoneal lavage

A protocol for cooperation to establish an International Gastric Cancer Unit (IGCU)

The following text shows the terms of a protocol for cooperation recently signed between the Department of Digestive Surgery - St. Mary’s Hospital (Terni, Italy; hereinafter “SMH”), the Department of Surgical Sciences - “La Sapienza” University (Rome, Italy; hereinafter “SUR”) and the Department of Gastric Surgery - Fujian Medical University Union Hospital (Fuzhou, Fujian Province, PRC; hereinafter “FMU”)

A protocol for cooperation to establish an International Gastric Cancer Unit (IGCU)

The following text shows the terms of a protocol for cooperation recently signed between The Department of Digestive Surgery - St. Mary’s Hospital (Terni, Italy; hereinafter “SMH”), the Department of Surgical Sciences - “La Sapienza” University (Rome, Italy; hereinafter “SUR”) and the Department of Gastric Surgery - Fujian Medical University Union Hospital (Fuzhou, Fujian Province, PRC; hereinafter “FMU”)