Developing a Robotic Gastrectomy Programme in Times of Change

Authors
Rui En Lee, Louis Wai, Daryl Chia, Asim Shabbir, Jimmy So, Guowei Kim

Affiliations
Division of General Surgery (Upper GI Surgery), Department of Surgery, University Surgical Cluster, National University Health System, Singapore

Abstract
The techniques of robotic gastrectomy are rapidly evolving. The purpose of this study was to describe our experience and challenges with robotic gastrectomy for gastric cancer in a low volume centre as we upgraded our robotic platform, whilst switching from a predominantly ultrasonic dissection-based technique to a combination of ultrasonic and double bipolar method.

This case series was performed in a tertiary university cancer referral center by one consultant upper gastrointestinal surgeon over the period of 2020 to 2023. Outcomes measured include patient demographics, operative time, blood loss, pain score, rates of complete resection, lymph node harvest, surgical complications and recurrence of disease. The Da Vinci Si and subsequently Xi system (Intuitive Surgical) was used.

Thirteen patients with gastric cancer were reviewed. Patients typically presented with symptoms of dyspepsia or loss of weight. The median age was 65 (range 42 to 88) and the median BMI was 23.7 (range 16.0 to 33.0). The median operative duration was 391 minutes (range 287 to 501 minutes) and the median blood loss was 100ml (range 50 to 200 ml). The median length of stay was 5 days (range 4 to 27 days). Histological examination showed clear resection margins with a median lymph node yield of 39 (range 23 to 100). There was one (7.7%) post-operative complication which was due to a para-anastomotic collection.

Our results show the feasibility of starting a robotic surgery program for gastric cancer, with acceptable outcomes.