• Da Vinci robot surgery system
• case report
• gastrectomy
• gastric cancer (GC)
• liver transplantation

• Humans
• Stomach Neoplasms/surgery
• Stomach Neoplasms/pathology
• Gastrectomy/methods
• Robotic Surgical Procedures/methods
• Liver Transplantation/methods
• Liver Transplantation/adverse effects
• Middle Aged
• Male
• Lymph Node Excision/methods
• Adenocarcinoma/surgery

• gastric cancer robotic gastrectomy laparoscopic gastrectomy

• gastrectomy
• gastric cancer
• learning curve
• robotic gastrectomy
• robotic surgery
• training

• Gastrectomy
• Humans
• Laparoscopy
• Learning Curve
• Operative Time
• Retrospective Studies
• Robotic Surgical Procedures
• Stomach Neoplasms/surgery
• Treatment Outcome

• gastric cancer
• minimally invasive gastrectomy
• radical gastrectomy
• robotic surgery
• survival

• Aged
• Female
• Gastrectomy/adverse effects
• Gastrectomy/methods
• Humans
• Male
• Operative Time
• Postoperative Complications/epidemiology
• Propensity Score
• Retrospective Studies
• Robotic Surgical Procedures/adverse effects
• Robotic Surgical Procedures/methods
• Stomach Neoplasms/mortality
• Stomach Neoplasms/surgery

Pneumoperitoneum and the head-up position reportedly stimulate the sympathetic nervous system, potentially increasing the risk of cardiac arrhythmia. We evaluated the effects of a long duration of pneumoperitoneum in the head-up position on the heart rate-corrected QT (QTc) interval during robotic gastrectomy.

This prospective observational study involved 28 patients undergoing robotic gastrectomy. The QTc interval was recorded at the following time points: before anaesthetic induction (baseline); 10 minutes after tracheal intubation; 1, 5, 30, 60, and 90 minutes after pneumoperitoneum induction in the head-up position; after pneumoperitoneum desufflation in the supine position; and at the end of surgery. The primary outcome was the QTc interval, which was measured 90 minutes after pneumoperitoneum combined with the head-up position.

Compared with baseline, the QTc interval was significantly prolonged at 1 and 60 minutes after pneumoperitoneum, peaked at 90 minutes, and was sustained and notably prolonged until the end of surgery. However, no considerable haemodynamic changes developed.

A long period of carbon dioxide pneumoperitoneum application in a head-up position significantly prolonged the QTc interval during robotic gastrectomy. Therefore, diligent care and close monitoring are required for patients who are susceptible to developing ventricular arrhythmia.

Trial Registration: Registered at ClinicalTrials.gov; https://clinicaltrials.gov/ct2/show/NCT02604979; Registration number NCT02604979

• Carbon dioxide pneumoperitoneum
• QTc interval
• anaesthesia
• cardiac arrhythmia
• head-up position
• robotic gastrectomy

To evaluate the potential effectiveness of robot-assisted gastrectomy (RAG) in comparison to open gastrectomy (OG) for gastric cancer patients.

A comprehensive systematic literature search using PubMed, EMBASE, and the Cochrane Library was carried out to identify studies comparing RAG and OG in gastric cancer. Participants of any age and sex were considered for inclusion in comparative studies of the two techniques independently from type of gastrectomy. A meta-analysis of short-term perioperative outcomes was performed to evaluate whether RAG is equivalent to OG. The primary outcome measures were set for estimated blood loss, operative time, conversion rate, morbidity, and hospital stay. Secondary among postoperative complications, wound infection, bleeding and anastomotic leakage were also analysed.

A total of 6 articles, 5 retrospective and 1 randomized controlled study, involving 6123 patients overall, with 689 (11.3%) cases submitted to RAG and 5434 (88.7%) to OG, satisfied the eligibility criteria and were included in the meta-analysis. RAG was associated with longer operation time than OG (weighted mean difference 72.20 min; P < 0.001), but with reduction in blood loss and shorter hospital stay (weighted mean difference -166.83 mL and -1.97 d respectively; P < 0.001). No differences were found with respect to overall postoperative complications (P = 0.65), wound infection (P = 0.35), bleeding (P = 0.65), and anastomotic leakage (P = 0.06). The postoperative mortality rates were similar between the two groups. With respect to oncological outcomes, no statistical differences among the number of harvested lymph nodes were found (weighted mean difference -1.12; P = 0.10).

RAG seems to be a technically valid alternative to OG for performing radical gastrectomy in gastric cancer resulting in safe complications.

• Robot-assisted gastrectomy
• Gastric resection
• Open gastrectomy
• Gastric cancer

Phase III evidence in the shape of a series of randomized controlled trials and meta-analyses has shown that laparoscopic gastrectomy is safe and gives better short-term results with respect to the traditional open technique for early-stage gastric cancer. In fact, in the East laparoscopic gastrectomy has become routine for early-stage gastric cancer. In contrast, the treatment of advanced gastric cancer through a minimally invasive way is still a debated issue, mostly due to worries about its oncological efficacy and the difficulty of carrying out an extended lymphadenectomy and intestinal reconstruction after total gastrectomy laparoscopically. Over the last ten years the introduction of robotic surgery has implied overcoming some intrinsic drawbacks found to be present in the conventional laparoscopic procedure. Robot-assisted gastrectomy with D2 lymphadenectomy has been shown to be safe and feasible for the treatment of gastric cancer patients. But unfortunately, most available studies investigating the robotic gastrectomy for gastric cancer compared to laparoscopic and open technique are so far retrospective and there have not been phase III trials. In the present review we looked at scientific evidence available today regarding the new high-tech surgical robotic approach, and we attempted to bring to light the real advantages of robot-assisted gastrectomy compared to the traditional laparoscopic and open technique for the treatment of gastric cancer.

• Gastric cancer
• Gastric resection
• Minimally invasive surgery
• Robot-assisted gastrectomy

Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are needed to evaluate the possible influence of robot gastrectomy on GC patient survival.

• Gastric cancer
• Gastric resection
• Minimally invasive surgery
• Laparoscopic gastrectomy
• Robot-assisted gastrectomy

• Adenocarcinoma/pathology
• Adenocarcinoma/surgery
• Gastrectomy/methods
• Humans
• Laparoscopy/methods
• Length of Stay
• Lymph Node Excision/methods
• Neoplasm Staging
• Robotic Surgical Procedures/methods
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Treatment Outcome

• SURGERY

• Databases, Factual
• Female
• Humans
• Laparoscopy/methods
• Male
• Minimally Invasive Surgical Procedures/methods
• Reproducibility of Results
• Research Design
• Retrospective Studies
• Robotics/instrumentation
• Stomach Neoplasms/surgery
• Treatment Outcome