Background: Docking the scope and instruments through a multi-channel trocar has enabled reduced-port robotic distal gastrectomy (RRDG) for gastric cancer. To facilitate lymphadenectomy over the anatomical hindrances during RRDG, we recently introduced the Vessel Sealer Extend®(VSE) (Intuitive Surgical, Sunnyvale, CA, USA), a bipolar vessel-sealing device (BVSD) with an articulating jaw. Methods: From May 2020 to August 2023, we performed RRDG to treat T1 gastric cancer. One endoscope arm and three instrument arms of the da Vinci®Xi Surgical System (Intuitive Surgical) were used. During the lymphadenectomy, the endoscope and VSE (Intuitive Surgical) were docked through a multi-channel trocar established on a trans-umbilical incision. Two Cardiere forceps were docked through cannulas established on each flank. A trans-umbilical lymphadenectomy using an articulating BVSD (TULAB) was then performed. Results: A total of 42 patients underwent planned RRDG with the TULAB technique. The number of retrieved lymph nodes did not differ between the patients who underwent RRDG and those who underwent conventional laparoscopic distal gastrectomies (CLDG) (p= 0.362). There was no statistically significant difference in postoperative complications between the RRDG and CLDG group (p= 0.189). The mean time to first semi-fluid diet was shorter in the patients who underwent RRDG than CLDG (p= 0.030), and the incidence of postoperative ileus was lower in the RRDG group than the CLDG group (0% and 9.9%, respectively,p= 0.034). Conclusions: Despite use of fewer ports, RRDG with TULAB had similar outcomes to CLDG in terms of the incidence of postoperative morbidity and the number of harvested lymph nodes. Furthermore, by reducing the number of incisions, the incidence of the intra-abdominal adhesions can potentially be lowered when RRDG is used.
背景：通过多通道套管进行内窥镜及器械对接，实现了胃癌减孔机器人远端胃切除术（RRDG）。为克服RRDG术中解剖障碍对淋巴结清扫的影响，我们近期引入了Vessel Sealer Extend®（VSE）（美国加利福尼亚州森尼韦尔市直观医疗公司），这是一种配备关节式钳口的双极血管闭合装置（BVSD）。方法：2020年5月至2023年8月期间，我们对T1期胃癌患者实施RRDG手术。手术采用达芬奇Xi外科手术系统（直观医疗公司）的1条内窥镜臂和3条器械臂。淋巴结清扫阶段，内窥镜与VSE（直观医疗公司）通过经脐切口建立的多通道套管进行对接，两把Cardiere钳分别通过双侧腹壁建立的套管置入。随后采用关节式BVSD实施经脐淋巴结清扫术（TULAB）。结果：共42例患者按计划接受TULAB技术下的RRDG手术。RRDG组与传统腹腔镜远端胃切除术（CLDG）组在淋巴结获取数量上无统计学差异（p=0.362）。两组术后并发症发生率亦无显著差异（p=0.189）。RRDG组患者术后首次半流质饮食时间较CLDG组显著缩短（p=0.030），且术后肠梗阻发生率更低（RRDG组0% vs CLDG组9.9%，p=0.034）。结论：尽管手术切口更少，采用TULAB技术的RRDG在术后并发症发生率和淋巴结获取数量方面与CLDG疗效相当。此外，通过减少切口数量，RRDG可能有助于降低腹腔内粘连的发生风险。
肿瘤(癌症)患者之家