Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2022; 14(10): 1107-1119
Published online Oct 27, 2022. doi: 10.4240/wjgs.v14.i10.1107
Performing robot-assisted pylorus and vagus nerve-preserving gastrectomy for early gastric cancer: A case series of initial experience
Chi Zhang, Mao-Hua Wei, Liang Cao, Yan-Feng Liu, Pin Liang, Xiang Hu
Chi Zhang, Mao-Hua Wei, Liang Cao, Yan-Feng Liu, Pin Liang, Xiang Hu, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
Author contributions: Zhang C performed the surgery and was responsible for manuscript writing, study design, data collection; Hu X performed the surgery and was responsible for study design; Wei MH and Liu YF performed the surgery; Liang P and Cao L performed the statistical analysis and literature review.
Institutional review board statement: The study was reviewed and approved by the ethics committee of First Affiliated Hospital of Dalian Medical University [Approval No. PJ-XJS-2022-02].
Informed consent statement: All study participants, or their legal guardian, provided written informed consent form.
Conflict-of-interest statement: The authors of this manuscript having no conflicts of interest to disclose.
Data sharing statement: There is no additional data available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chi Zhang, MD, Doctor, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Xigang District, Dalian 116011, Liaoning Province, China. 18098875983@163.com
Received: February 21, 2022
Peer-review started: February 21, 2022
First decision: April 19, 2022
Revised: May 15, 2022
Accepted: July 19, 2022
Article in press: July 19, 2022
Published online: October 27, 2022
Abstract
BACKGROUND

Pylorus and vagus nerve-preserving gastrectomy (PPG) is a function-preserving surgery for early gastric cancer (GC) that has gained considerable interest in the recent years. The operative technique performed using the Da Vinci Xi robot system is considered ideal for open and laparoscopic surgery.

AIM

To introduce Da Vinci Xi robot-assisted PPG (RAPPG)-based operative procedure and technical points as well as report the initial experience based on the clinical pathology data of eight cases of early GC.

METHODS

Da Vinci Xi robot-assisted pylorus and vagus nerve-preserving gastrectomy (RAPPG) was performed for 11 consecutive patients with middle GC from December 2020 to July 2021. Outcome measures were postoperative morbidity, operative time, blood loss, number of lymph nodes harvested, postoperative hospital stay, time to first flatus, time to diet, and resection margins.

RESULTS

Eight of the 11 patients who were pathologically diagnosed with early GC were enrolled in a retrospective study to assess the feasibility and safety of RAPPG. The mean operative time, mean blood loss, mean number of lymph nodes harvested, length of preserved pylorus canal, distal margin, and proximal margin were 330.63 ± 47.24 min, 57.50 ± 37.70 mL, 18.63 ± 10.57, 3.63 ± 0.88 cm, 3.50 ± 1.31 cm, and 3.63 ± 1.19 cm, respectively. None of the cases required conversion to laparotomy. Postoperative complications occurred in two (25.0%) patients. Postoperative complications were hyperamylasemia and gastric stasis in one case and incision infection in the other. Time to first flatus was 3.75 ± 2.49 d after the operation, and postoperative hospital stay was 10.13 ± 4.55 d.

CONCLUSION

The core technique in the Da Vinci Xi RAPPG is lymph node dissection and the anatomic method of the nerve. Robotic surgical procedures are feasible and safe. With the progress of surgical technology, optimization of medical insurance structure, and emergence of evidence-based medicine, automated surgery systems will have a broad application in clinical treatment.

Keywords: Da Vinci robotic surgery system, Gastric carcinoma, Vagus nerve, Pylorus, Gastrectomy

Core Tip: The robotic surgery system is widely used in the surgical field. Pylorus and vagus nerve-preserving gastrectomy is a function-preserving surgery for early gastric cancer (GC). We introduced an robot-assisted pylorus and vagus nerve-preserving gastrectomy-based operative procedure and technical points as well as report the initial experience. We analyzed the the mean operative time, mean blood loss, mean number of lymph nodes harvested, length of preserved pylorus canal, distal margin, proximal margin, and postoperative complications of 8 patients with early GC. None of the cases required conversion to laparotomy. The main postoperative complications were hyperamylasemia and gastric stasis. These study results are preliminary, and on establishing a standard surgical treatment, large-sample, multi-center, and prospective clinical trial should be conducted.