Page 17 - WJOLS - Journal of Laparoscopic Surgery

WJOLS

Abhay Singhal et al 10.5005/jp-journals-10033-1315
REVIEW ARTICLE

Can Robotic Gastrectomy be considered as Gold Standard

for Upcoming Surgeons? A Multi-institutional Comparative
Review

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1 Abhay Singhal, Swati Garg, Rajneesh K Mishra, Jatinder S Chowhan
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ABSTRACT improve short-term results and the patient’s quality of
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Surgical techniques have evolved tremendously over this past life when compared with open surgery. While in the
century. Minimally invasive surgery for gastric cancer is not Western world, development of laparoscopic gastrectomy
a new research field, but still an important problem remains (LG) has been very slow and is not yet considered an
regarding the selection of the appropriate technique for a given acceptable alternative to standard open surgery. This
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gastric cancer case. Although evidence is limited, the use of the
robotic surgery platform is far assessed as a feasible and safe skepticism is basically due to the technical complexity of
procedure, which is also easier to learn as less than 10 cases LG and concerns about the feasibility of an oncologically
of robotic surgery are needed to become proficient therein. acceptable lymphadenectomy. For these reasons, LG is
This review will however cover in-depth review of retrospective considered one of the most difficult operations, requiring
reports, analyzing the pros and cons of robotic surgery and a long learning curve of about 40 to 50 cases. 9
highlighting the remaining study questions.
Robotic systems include operator-controlled three-
Keywords: Gastrectomy, Gastric cancer surgery, Minimally dimensional cameras that ensure steady and effective
invasive surgery, Robotic surgery. surgical fields of view with motion scaling and tremor
How to cite this article: Singhal A, Garg S, Mishra RK, suppression, multiple degrees of freedom with instru-
Chowhan JS. Can Robotic Gastrectomy be considered as ment flexibility, and improved ergonomics. 10-13 It is
Gold Standard for Upcoming Surgeons? A Multi-institutional believed that this technological evolution can assist
Comparative Review. World J Lap Surg 2017;10(3):98-101.
the surgeon with complex surgical procedures that are
Source of support: Nil required in radical gastrectomy, such as precise lymph
Conflict of interest: None node dissection and intracorporeal anastomoses. 4
However, the number of robotic gastrectomies per-
formed per year has been increasing, particularly in East
INTRODUCTION
Asia where the incidence of gastric cancer is high and
Surgery is unanimously considered the mainstay curative approximately half of the cases are diagnosed as early
treatment in gastric cancer. Technically, the possibilities gastric cancer. The use of the robotic platforms in general
range from open surgery to minimally invasive methods, surgery did not enjoy the same success as it did in urologic
such as laparoscopy or robotic surgery. Although mini- surgery, and the field of gastric cancer is no exception.
mally invasive surgery for gastric cancer has evolved Robotic surgery till now has only proven its safety and
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rapidly, it has increased in popularity during the last two feasibility in early gastric cancer. The current challenge
decades mainly in the Far East and for patients with early- for robotic surgery in gastric cancer is to prove its effective-
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stage tumors. A number of trials and meta-analyses have ness and benefit as a treatment option, ideally in the form
confirmed that laparoscopic surgery for gastric cancer can of a survival advantage and steep learning curve as com-
pared with open and conventional laparoscopic surgery.

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1 Senior Resident, Junior Consultant, Professor and Head MATERIALS AND METHODS
4 Senior Consultant
1 Department of General Surgery, Lady Hardinge Medical Literatures that published in English in years 2016 and
College & Associated SSK & KSC Hospitals, New Delhi, India 2017 were searched in PubMed and Knowledge Genie,
2 Vrinda Diagnostic Centre, Ghaziabad, Uttar Pradesh, India using the search terms “robotic gastrectomy” (RG) and
3 Department of Minimal Access Surgery TGO University “gastric cancer” along with their synonyms or abbrevia-
Gurugram, Haryana, India tions. Then all titles, abstracts, or related citations were
4 Department of Laparoscopic and Robotic Surgery, World scanned and reviewed, and the references of each identi-
Laparoscopy Hospital, Gurugram, Haryana, India fied articles were also evaluated. Large-scale prospective
Corresponding Author: Abhay Singhal, R-2/235 Raj Nagar cohort studies, retrospective case–control studies, and
Ghaziabad, Uttar Pradesh 201002, India, Phone: +919810014448 case series were also reviewed of which lastly five articles
e-mail: abhaysinghal22@gmail.com
were selected for the review.
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