Full robotic Roux-en-Y reconstruction after gastrectomy for gastric cancer: a loop reconstruction technique
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TECHNICAL NOTE
Full robotic Roux‑en‑Y reconstruction after gastrectomy for gastric cancer: a loop reconstruction technique Toshiyasu Ojima1 · Masaki Nakamura1 · Hiroki Yamaue1 Received: 1 July 2020 / Accepted: 11 September 2020 © Italian Society of Surgery (SIC) 2020
Abstract A robotic approach with radical lymph node dissection for gastric cancers is a safe and effective surgical procedure. However, there are still only a few studies in the reconstruction procedure after gastrectomy and many aspects of the use of the robotic surgical system remain controversial. In Roux-en-Y reconstruction, most institutions are adapted for reconstruction using small laparotomy due to the complicated procedure. We, therefore, developed a new and easy procedure for full robotic Rouxen-Y reconstruction after robotic gastrectomy. We named this procedure “loop reconstruction technique”. This article including video shows our loop reconstruction technique with an intracorporeal robot-sewn anastomosis after robotic gastrectomy. Keywords Gastric cancer · Robotic surgery · Roux-en-Y reconstruction · Loop reconstruction technique For the treatment of gastric cancer (GC), several published studies suggest a robotic approach with radical lymph node dissection as a safe and effective surgical procedure [1, 2]. The reconstruction procedure after gastrectomy has not been widely reported, however, and many aspects of the use of the robotic surgical system remain controversial [2]. The reconstructive phase can be divided into two major categories based on the approach adopted: the execution of extracorporeal versus intracorporeal anastomosis. In Roux-en-Y reconstruction, most institutions have employed reconstruction using small laparotomy due to the complexity of the procedure. Especially full robotic esophagojejunostomy after total gastrectomy is difficult. As an alternative, we report our new and simple procedure for full robotic Roux-en-Y reconstruction after robotic gastrectomy (RG). We named this procedure the loop reconstruction technique. We performed robotic distal gastrectomy (RDG) for GC localized in the lower/middle third of the stomach using the da Vinci Surgical System (Intuitive, Sunnyvale, CA). If GC is in the upper third of the stomach, we performed robotic total gastrectomy (RTG). This video shows our loop reconstruction technique with an intracorporeal robotsewn anastomosis after RG. After RDG, intracorporeal * Toshiyasu Ojima tojima@wakayama‑med.ac.jp 1
Second Department of Surgery, Wakayama Medical University, 811‑1, Kimiidera, Wakayama 641‑8510, Japan
gastrojejunostomy was performed by side-to-side anastomosis using a robotic linear 45-mm stapling device (SureForm, Intuitive) (Fig. 1). This is the same as reverse peristaltic loop gastrojejunostomy through the antecolic route. The entry incision of the robotic linear stapler was closed with a robotic full-thickness running suture. A side-to-side jejunojejunostomy for Y-limb creation was also constructed with SureForm 45-mm long linear stapler and a 10-cm sacrificial i
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