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Il Giornale di Chirurgia

Gastrectomia mini-invasiva robotica: fasi tecniche e vantaggi dell’approccio robotico

Articolo, 132 - 137
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Aim of the study.To show the technical steps and advantages of robotic total/subtotal gastrectomy.
Material & Methods. Between 2000 and 2009, 96 robotic gastric resections have been performed: 45 total gastrectomies, 48 subtotal gastrectomies and 3 partial resections. Patient is in supine position, with 10°-15° reverse-Trendelemburg. Five ports are placed in
half concave line. Preliminary exploration, gastro-colic detachment and short gastric vessels section are performed in traditional laparoscopy.
The robotic cart is then installed. Infra-pyloric lymphadenectomy and right gastroepiploic vessels section is completed before the transection of the duodenum with a linear endostapler. Lymphadenectomy is performed in a clockwise fashion along the hepatic proper, common hepatic, celiac trunk and splenic artery. The right gastric artery, the left gastric artery and vein are sectioned in the process. In total gastrectomy the distal oesophagus is mobilized after lymphadenectomy of pericardial stations and sectioned, then an anastomosis by circular stapler was performed. After subtotal gastrectomy, the gastro-intestinal anastomosis is performed by stapler or robotic hand-suturing. The specimen is retrieved through a mini-laparotomy in the right flank.
Results. Average intra-operative time was 280 min (range:120-480). Conversion was necessary in eight patients: 2 cases to laparoscopy (one splenic injury, one robotic arm failure), 6 cases to open surgery (locally advanced or metastatic disease). The mean number of removed nodes in D2 was 32.2 (range 19-70). Postoperative morbidity and mortality were respectively 19.8% and 3.1%. Anastomotic and duodenal stump leakage occurred respectively in 11 and 3 cases (11.4% and 3.1%). A redo-surgery was necessary in 7 patients (7.3%). Mean postoperative hospital stay was 11.6 days.
Conclusion. Robotic total/subtotal gastrectomy is a feasible, safe and oncologically adequate procedure.

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