Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2022; 14(10): 1107-1119
Published online Oct 27, 2022. doi: 10.4240/wjgs.v14.i10.1107
Performing robot-assisted pylorus and vagus nerve-preserving gastrectomy for early gastric cancer: A case series of initial experience
Chi Zhang, Mao-Hua Wei, Liang Cao, Yan-Feng Liu, Pin Liang, Xiang Hu
Chi Zhang, Mao-Hua Wei, Liang Cao, Yan-Feng Liu, Pin Liang, Xiang Hu, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
Author contributions: Zhang C performed the surgery and was responsible for manuscript writing, study design, data collection; Hu X performed the surgery and was responsible for study design; Wei MH and Liu YF performed the surgery; Liang P and Cao L performed the statistical analysis and literature review.
Institutional review board statement: The study was reviewed and approved by the ethics committee of First Affiliated Hospital of Dalian Medical University [Approval No. PJ-XJS-2022-02].
Informed consent statement: All study participants, or their legal guardian, provided written informed consent form.
Conflict-of-interest statement: The authors of this manuscript having no conflicts of interest to disclose.
Data sharing statement: There is no additional data available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chi Zhang, MD, Doctor, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Xigang District, Dalian 116011, Liaoning Province, China. 18098875983@163.com
Received: February 21, 2022
Peer-review started: February 21, 2022
First decision: April 19, 2022
Revised: May 15, 2022
Accepted: July 19, 2022
Article in press: July 19, 2022
Published online: October 27, 2022
Processing time: 246 Days and 3.9 Hours
ARTICLE HIGHLIGHTS
Research background

Pylorus and vagus nerve-preserving gastrectomy (PPG) as a function-preserving surgical treatment has gained gradual acceptance and promotion. Although laparoscopic techniques are improving, the “chopstick” effect caused by the parallel arrangement of the instruments in the umbilicus is considered an obstacle in delicate operations. The results of study showed that operative time of the robot-assisted pylorus-preserving gastrectomy (RAPPG) was longer, but there was no significant difference in complications and the number of examined lymph nodes compared with laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG).

Research motivation

In order to formulate the reasonable surgical process and technical standards for RAPPG.

Research objectives

To introduce Da Vinci Xi RAPPG-based operative procedure and technical points as well as report theinitial experienc.

Research methods

This retrospective analysis of clinical and pathological data of 8 early middle gastric cancer (GC) cases who have performed RAPPG.The fundamental techniques of RAPPG are (1) The inferior pylorus artery and vein were preserved during operation; and (2) The right diaphragmatic foot approach was combined with the left retroperitoneal approach to determine the distribution of the vagus nerve.

Research results

There were no laparoscopic conversions or intraoperative complications. The mean intraoperative blood loss was 57.50 ± 37.70 mL; the mean operative time was 330.63 ± 47.24 min .The incidence of complications was 25.0%.

Research conclusions

The core technique in the RAPPG is lymph node dissection and the anatomic method of the nerve. Robotic surgical procedures are feasible and safe. Reasonable surgical process, close cooperation of the surgical team, rational use of energy equipment, and avoidance of surgical risks are key factors to ensure surgical quality.

Research perspectives

This study aimed to highlight the surgical process, technical details, technical points, and precautions of RAPPG and retrospectively analyze the short-term prognosis of early GC cases. More cases should be accumulated, long-term follow-up should be conducted, and data should be compared with data for LAPPG to gather more data for RAPPG in the treatment of patients with early GC.