Robotic Gastrectomy: How I do it

Speaker

Takahiro KINOSHITA Chief Director Department of Gastric Surgery National Cancer Center Hospital East, Japan

Takahiro KINOSHITA
Chief Director
Department of Gastric Surgery
National Cancer Center Hospital East, Japan

Talk Abstract

Robotic surgery for gastric cancer is spreading rapidly in Japan after the coverage by the public health insurance. The precise operation is expected to reduce postoperative complications, enable complex function-preserving surgery, and be combined with modern perioperative treatment (e.g. chemotherapy, immunotherapy). I started robotic surgery for gastric cancer in 2014 and have experienced 550 cases so far. I have improved various techniques and have reached the current technique that I do now. I would like to emphasize the following features of my technique.

1. Low-voltage bipolar dissection: I perform Maryland bipolar dissection at a voltage setting of 200 V or lower to minimize thermal damage to the adjacent tissue and to ensure coagulation without charring. Although it is a little difficult to cut the tissue after coagulation and requires some skill or tips, but once mastered, clean lymph node dissection can be performed without bleeding. Ans also, it is really useful for difficult cases, such as far advanced cases or after neoadjuvant chemotherapy.

2. Reconstruction using robotic staplers and robotic suture manipulation: Robotic stapler with four-way articulation are advantageous for reconstruction in delicate areas (gastroduodenal anastomosis, esophageal jejunal anastomosis, etc.). Function-preserving surgeries with complicated suture manipulation, such as the Kamikawa method, are also a specialty of robotic surgery.

In this presentation, these techniques will be explained with the use of video clips.