scholarly journals Reduced-port totally robotic distal subtotal gastrectomy for gastric cancer: 100 consecutive cases in comparison with conventional robotic and laparoscopic distal subtotal gastrectomy

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Won Jun Seo ◽  
Taeil Son ◽  
Hyejung Shin ◽  
Seohee Choi ◽  
Chul Kyu Roh ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Minimally Invasive ◽  
Learning Curve ◽  
Inflammatory Responses ◽  
Subtotal Gastrectomy ◽  
Operation Time ◽  
Curve Analysis ◽  
Safe Alternative ◽  
Reduced Port Surgery ◽  
Reduced Port

Abstract By overcoming technical difficulties with limited access faced when performing reduced-port surgery for gastric cancer, reduced-port totally robotic gastrectomy (RPRDG) could be a safe alternative to conventional minimally invasive gastrectomy. An initial 100 consecutive cases of RPRDG for gastric cancer were performed from February 2016 to September 2018. Short-term outcomes for RPRDG with those for 261 conventional laparoscopic (CLDG) and for 241 robotic procedures (CRDG) over the same period were compared. Learning curve analysis for RPRDG was conducted to determine whether this procedure could be readily performed despite fewer access. During the first 100 cases of RPRDG, no surgeries were converted to open or laparoscopic surgery, and no additional ports were required. RPRDG showed longer operation time than CLDG (188.4 min vs. 166.2 min, p < 0.001) and similar operation time with CRDG (183.1 min, p = 0.315). The blood loss was 35.4 ml for RPRDG, 85.2 ml for CLDG (p < 0.001), and 41.2 ml for CRDG (p = 0.33). The numbers of retrieved lymph nodes were 50.5 for RPRDG, 43.9 for CLDG (p = 0.003), and 55.0 for CRDG (p = 0.055). Postoperative maximum C-reactive protein levels were 96.8 mg/L for RPRDG, 87.8 mg/L for CLDG (p = 0.454), and 81.9 mg/L for CRDG (p = 0.027). Learning curve analysis indicated that the overall operation time of RPRDG stabilized at 180 min after 21 cases. The incidence of major postoperative complications did not differ among groups. RPRDG for gastric cancer is a feasible and safe alternative to conventional minimally invasive surgery. Notwithstanding, this procedure failed to reduce postoperative inflammatory responses.

scholarly journals Short-term and long-term outcomes of robotic, laparoscopic and open radical gastrectomy in gastric cancer: A single-center retrospective study

2019 ◽  
Author(s):  
Weifan Zhang ◽  
Xinhui Zhao ◽  
Zhao Liu ◽  
Hui Dang ◽  
Lei Meng ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Nodes ◽  
Learning Curve ◽  
Operation Time ◽  
Open Gastrectomy ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Estimated Blood Loss

Abstract Background: Few studies on the comparison among robotic, laparoscopic, and open gastrectomy had been reported in gastric cancer . The goal of this study was to evaluate the advantages of robotic-assisted gastrectomy (RAG) by comparing with laparoscopic-assisted gastrectomy(LAG) and open gastrectomy (OG). Methods: 147 gastric cancer patients who underwent gastrectomy were enrolled and retrospectively analyzed between January 2017 and July 2019. Short-term outcomes such as operation time, intraoperative estimated blood loss(EBL),number of retrieved lymph nodes, postoperative recovery, learning curve, and long-term outcome such as overall survival(OS) was compared among RAG, LAG and OG groups. Results: RAG group included 47 patients, 44 in the LAG, and 61 in the OG. Basic information such as gender, age, BMI, ASA degree were similar among three groups, and there were no statistically significances in pathological TNM staging, tumor resection extent, resection margin, methods of reconstruction( P ＞0.05). The cumulative sum(CUSUM) method showed that learning curve of RAG reached stability after 17 cases . For short-term outcomes, the RAG group had the shortest EBL( P =0.033), the shortest time to first flatus( P ＜0.001), shortest time to first intake liquid diet ( P =0.004),shortest postoperative hospital stay ( P =0.023)and the largest number of retrieved lymph nodes( P =0.044),the longest operation time( P ＜0.001), the most expensive treatment cost( P ＜0.001),however, there were no significant differences in postoperative drainage, postoperative white blood cell(WBC)count and early complications among three group( P ＞0.05). In addition to long-term outcome, similar OS was observed in three groups. Conclusion: Compared with LAG and OG, RAG has certain advantages in short-term outcomes and is a safe and reliable surgical method. But still need further prospective, multi-center research to confirm this.

Reduced port surgery and reduced surgical staff surgery for gastric cancer

2017 ◽  
Vol 2 ◽  
pp. 75-75
Author(s):  
Shinsuke Usui ◽  
Masaki Tashiro ◽  
Shigeo Haruki ◽  
Noriaki Takiguchi
Keyword(s):  
Gastric Cancer ◽  
Reduced Port Surgery ◽  
Reduced Port

scholarly journals Learning curve of trans-sacral epiduroscopic laser decompression in herniated lumbar disc disease

2020 ◽  
Author(s):  
Seong Son ◽  
Chan Jong Yoo ◽  
Byung Rhae Yoo ◽  
Woo Seok Kim ◽  
Tae Seok Jeong
Keyword(s):  
Clinical Outcome ◽  
Minimally Invasive ◽  
Learning Curve ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Operation Time ◽  
Early Group ◽  
Significant Difference ◽  
Late Group

Abstract Background: Trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscope and a holmium YAG laser is one of the minimally invasive surgical options for lumbar disc herniation. However, the learning curve of SELD and the effect of surgical proficiency on clinical outcome have not yet been established. We investigated patients with lumbar disc herniation undergoing SELD to report the clinical outcome and learning curve. Methods: Retrospective analysis of clinical outcome and learning curve were performed at a single center from clinical data collected from November 2015 to November 2018. A total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. Based on the findings that the cut-off of familiarity was 20 cases according to the cumulative study of operation time, patients were allocated to two groups: early group (n = 20) and late group (n = 62). The surgical, clinical, and radiological outcomes were retrospectively evaluated between the two groups to analyze the learning curve of SELD.Results: According to linear and log regression analyses, the operation time was obtained by the formula: operation time = 58.825 - (0.181 × [case number]) (p < 0.001). The mean operation time was significantly different between the two groups (mean 56.95 minutes; 95% confidence interval [CI], 49.12–64.78 in the early group versus mean 45.34 minutes; 95% CI, 42.45–48.22 in the late group; p = 0.008, non-parametric Mann-Whitney U test).Baseline characteristics, including demographic data, clinical factors, and findings of preoperative magnetic resonance imaging, did not differ between the two groups. Also, there was no significant difference in terms of surgical outcomes, including complication and failure rates, as well as clinical and radiological outcomes between the two groups.Conclusion: The learning curve of SELD was not as steep as that of other minimally invasive spinal surgery techniques, and the experience of surgery was not an influencing factor for outcome variation.

scholarly journals Learning curve of trans-sacral epiduroscopic laser decompression in herniated lumbar disc disease

2020 ◽  
Author(s):  
Seong Son ◽  
Chan Jong Yoo ◽  
Byung Rhae Yoo ◽  
Woo Seok Kim ◽  
Tae Seok Jeong
Keyword(s):  
Clinical Outcome ◽  
Minimally Invasive ◽  
Learning Curve ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Operation Time ◽  
Early Group ◽  
Significant Difference ◽  
Late Group

Abstract Background: Trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscope and a holmium YAG laser is one of the minimally invasive surgical options for lumbar disc herniation.However, the learning curve of SELD and the effect of surgical proficiency on clinical outcome have not yet been established. We investigated patients with lumbar disc herniation undergoing SELD to report the clinical outcome and learning curve.Methods: Retrospective analysis of clinical outcome and learning curve were performed at a single center from clinical data collected from November 2015 to November 2018. A total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. Based on the findings that the cut-off of familiarity was 20 cases according to the cumulative study of operation time, patients were allocated to two groups: early group (n = 20) and late group (n = 62). The surgical, clinical, and radiological outcomes were retrospectively evaluated between the two groups to analyze the learning curve of SELD.Results: According to linear and log regression analyses, the operation time was obtained by the formula: operation time = 58.825 - (0.181 × [case number]) (p < 0.001). The mean operation time was significantly different between the two groups (mean 56.95 minutes; 95% confidence interval [CI], 49.12–64.78 in the early group versus mean 45.34 minutes; 95% CI, 42.45–48.22 in the late group; p = 0.008, non-parametric Mann-Whitney U test).Baseline characteristics, including demographic data, clinical factors, and findings of preoperative magnetic resonance imaging, did not differ between the two groups. Also, there was no significant difference in terms of surgical outcomes, including complication and failure rates, as well as clinical and radiological outcomes between the two groups.Conclusion: The learning curve of SELD was not as steep as that of other minimally invasive spinal surgery techniques, and the experience of surgery was not an influencing factor for outcome variation.

scholarly journals Feasibility and Safety of Laparoscopy-Assisted Subtotal Gastrectomy for Gastric Cancer Invading the Upper Stomach

2016 ◽  
Vol 101 (11-12) ◽  
pp. 577-582
Author(s):  
Takehiro Wakasugi ◽  
Haruhiko Cho ◽  
Tsutomu Sato ◽  
Toru Aoyama ◽  
Takashi Ogata ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Open Surgery ◽  
Subtotal Gastrectomy ◽  
Circular Stapler ◽  
Operation Time ◽  
Remnant Stomach ◽  
Conversion To Open Surgery ◽  
Anastomotic Bleeding ◽  
Duodenal Stump Leakage ◽  
Median Operation Time

This study evaluated the feasibility and safety of laparoscopy-assisted subtotal gastrectomy preserving a minimal remnant stomach for clinical T1 gastric cancer invading the upper stomach. Forty-three consecutive patients who underwent laparoscopy-assisted subtotal gastrectomy preserving a minimal remnant stomach were examined. In addition to the conventional laparoscopy-assisted distal gastrectomy, some short and posterior gastric arteries were resected. A minimal remnant stomach-jejunum anastomosis was made by using a circular stapler with regular anvil or transoral anvil. Transoral anvil was selected in 19 patients, and regular anvil was used in 24 patients. The median operation time was 288 minutes, and the median blood loss was 50 mL. Conversion to open surgery was required in 2 patients due to bleeding. No patient required conversion to open surgery due to the difficulty of the anastomosis. Nine patients developed postoperative complications, including grade 3 duodenal stump leakage in 1 patient and grade 2 anastomotic bleeding in another patient. No mortality was observed. Laparoscopy-assisted subtotal gastrectomy preserving a minimal remnant stomach is safe and feasible for early gastric cancer invading the upper stomach.

scholarly journals Compliance with D2 lymph node dissection in reduced-port totally laparoscopic distal gastrectomy in patients with gastric cancer

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sung Eun Oh ◽  
Jeong Eun Seo ◽  
Ji Yeong An ◽  
Min-Gew Choi ◽  
Tae Sung Sohn ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Distal Gastrectomy ◽  
Compliance Rate ◽  
Laparoscopic Distal Gastrectomy ◽  
D2 Lymphadenectomy ◽  
Reduced Port Surgery ◽  
Totally Laparoscopic Distal Gastrectomy ◽  
Reduced Port ◽  
Totally Laparoscopic

AbstractThis phase II clinical trial was performed to determine whether reduced-port laparoscopic surgery with complete D2 lymph node (LN) dissection for gastric cancer is a safe and feasible surgical technique. The prospectively enrolled 65 gastric cancer patients underwent reduced-port surgery (i.e., triple-incision totally laparoscopic distal gastrectomy [Duet TLDG] with D2 lymphadenectomy). Compliance rate was the primary outcome, which was defined as cases in which there was no more than one missing LN station during D2 LN dissection. The secondary outcomes were the numbers of dissected and retrieved LNs in each station and other short-term surgical outcomes and postoperative course. The compliance rate was 58.5%. The total number of retrieved LNs was 41 (range: 14–83 LNs). The most common station missing from LN retrieval was station no. 5 (35/65; 53.8%), followed by station no. 1 (24/65; 36.9%). The overall postoperative complication rate was 20.0% (13/65). One patient underwent surgical treatment for postoperative complications. There was no instances of mortality. Duet TLDG is an oncologically and technically safe surgical method of gastrectomy and D2 lymphadenectomy.

scholarly journals Learning curve of trans-sacral epiduroscopic laser decompression in herniated lumbar disc disease

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Seong Son ◽  
Chan Jong Yoo ◽  
Byung Rhae Yoo ◽  
Woo Seok Kim ◽  
Tae Seok Jeong
Keyword(s):  
Clinical Outcome ◽  
Minimally Invasive ◽  
Learning Curve ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Operation Time ◽  
Early Group ◽  
Significant Difference ◽  
Late Group

Abstract Background Trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscope and a holmium YAG laser is one of the minimally invasive surgical options for lumbar disc herniation. However, the learning curve of SELD and the effect of surgical proficiency on clinical outcome have not yet been established. We investigated patients with lumbar disc herniation undergoing SELD to report the clinical outcome and learning curve. Methods Retrospective analysis of clinical outcome and learning curve were performed at a single center from clinical data collected from November 2015 to November 2018. A total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. Based on the findings that the cut-off of familiarity was 20 cases according to the cumulative study of operation time, patients were allocated to two groups: early group (n = 20) and late group (n = 62). The surgical, clinical, and radiological outcomes were retrospectively evaluated between the two groups to analyze the learning curve of SELD. Results According to linear and log regression analyses, the operation time was obtained by the formula: operation time = 58.825–(0.181 × [case number]) (p < 0.001). The mean operation time was significantly different between the two groups (mean 56.95 min; 95% confidence interval [CI], 49.12–64.78 in the early group versus mean 45.34 min; 95% CI, 42.45–48.22 in the late group; p = 0.008, non-parametric Mann–Whitney U test). Baseline characteristics, including demographic data, clinical factors, and findings of preoperative magnetic resonance imaging, did not differ between the two groups. Also, there was no significant difference in terms of surgical outcomes, including complication and failure rates, as well as clinical and radiological outcomes between the two groups. Conclusion The learning curve of SELD was not as steep as that of other minimally invasive spinal surgery techniques, and the experience of surgery was not an influencing factor for outcome variation.

scholarly journals Early results of laparoscopic subtotal gastrectomy for gastric cancer

2020 ◽  
Vol 10 (3) ◽  
Author(s):  
Vũ Tuấn Anh Nguyễn ◽  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Node Dissection ◽  
Subtotal Gastrectomy ◽  
Operation Time ◽  
Viet Nam ◽  
Node Dissection ◽  
Average Hospital ◽  
D2 Lymph Node Dissection ◽  
Laparoscopic Subtotal Gastrectomy

Tóm tắt Đặt vấn đề: PTNS cắt bán phần dưới dạ dày điều trị ung thư biểu mô dạ dày đã dần được chấp nhận và áp dụng rộng rãi. Tuy nhiên, ngay cả với những phẫu thuật viên nhiều kinh nghiệm, PTNS cắt gần toàn bộ dạ dày điều trị ung thư biểu mô dạ dày, với phần dạ dày còn lại sau cắt rất nhỏ (10 – 20%), vẫn còn nhiều thử thách và nhiều tranh cãi, đặc biệt là khả năng nạo hạch hệ thống cũng như tái lập lưu thông sau cắt gần toàn bộ dạ dày. Tại Việt Nam, chưa có bất cứ nghiên cứu nào về phẫu thuật nội soi hoàn toàn cắt gần toàn bộ dạ dày nạo hạch tiêu chuẩn D2 điều trị ung thư biểu mô dạ dày, đặc biệt là cho nhóm ung thư biểu mô dạ dày vị trí 1/3 giữa. Phương pháp nghiên cứu: nghiên cứu tiến cứu, tại bệnh viện Đại học Y Dược TP HCM có 40 người bệnh (NB) ung thư biểu mô dạ dày được PTNS cắt gần toàn bộ dạ dày và nạo hạch tiêu chuẩn D2 trong khoảng thời gian từ tháng 1 năm 2018 đến tháng 5 năm 2019. Các dữ liệu lâm sàng và kết quả phẫu thuật được lượng giá. Kết quả: Thời gian phẫu thuật trung bình là 224,5 phút (từ 150 phút đến 360 phút), lượng máu mất trung bình là 25,6 ml (từ 10ml đến 200ml). Thời gian tái lập lưu thông trung bình là 32 phút (từ 15 phút đến 50 phút). Không có biến chứng trong mổ. Không có tử vong sau mổ. Biến chứng sau mổ gặp 2 trường hợp (5%): 1 tràn dịch màng phổi trái, và 1 nhiễm trùng vết mổ. Thời gian nằm viện trung bình là 7,8 ngày (từ 5 đến 14 ngày). Không có trường hợp nào xì miệng nối dạ dày hỗng tràng hoặc mỏm tá tràng. Kết luận: PTNS cắt gần toàn bộ dạ dày điều trị ung thư dạ dày nạo hạch tiêu chuẩn là an toàn, khả thi. Hơn nữa kỹ thuật này có thể thực hiện đối với ung thư dạ dày 1/3 giữa, thậm chí 1/3 trên, và có thể áp dụng thường qui. Abstract Background: Laparoscopic distal gastrectomy for adenocarcinoma has been accepted and worldwide applied. However, even experienced surgeons, laparoscopic subtotal gastrectomy for adenocarcinoma, remaining small part of stomach (10 – 20%) are still challenges and discussable issue among surgeons around the world, especially in lymph node dissection and reconstruction of intestinal tract. Nowadays in Viet Nam, no research about laparoscopic subtotal gastrectomy with standard D2 lymph node dissection for adenocarcinoma is available, especially the lesion is located in one third part of stomach. Materials and Method: This is a prospective study, conducted at the Pharmacy and Medicine University in Ho Chi Minh city. 40 patients underwent the laparoscopic subtotal gastrectomy associated with the standard lymph node dissection from Jan 2018 to May 2019 enrolled. The clinical database and surgical outcomes were assessed and quantified. Results: The average operation time was 224,5 minutes ( from 150 to 360 minutes), average blood loss is 25,6 ml (range, 10 to 90ml), average anastomosis time is 32 minutes (range, 15 to 50 minutes). No complications were observed during surgery. There were no deaths, and post-operative morbidity were two cases, accounted for 5%: one pleural effusion, and one surgical site infection. The average hospital length stay was 7,8 days ( from 5 to 14 days). No leakage of gastrojejunostomy or duodenal stump fistula. Conclusions: Laparoscopic subtotal gastrectomy with standard D2 lymph node dissection for gastric cancer is safe, feasible. Additionally, it is also reliable gastric cancers located in middle third, and even upper third of stomach, and could be routinely applied. Key words: Gastric cancer, laparoscopic surgery, subtotal gastrectomy.

scholarly journals Learning curve of trans-sacral epiduroscopic laser decompression in herniated lumbar disc disease

2020 ◽  
Author(s):  
Seong Son ◽  
Chan Jong Yoo ◽  
Byung Rhae Yoo ◽  
Woo Seok Kim ◽  
Tae Seok Jeong
Keyword(s):  
Clinical Outcome ◽  
Minimally Invasive ◽  
Learning Curve ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Operation Time ◽  
Early Group ◽  
Significant Difference ◽  
Late Group

Abstract Background: Trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscope and a holmium YAG laser is one of the minimally invasive surgical options for lumbar disc herniation.However, the learning curve of SELD and the effect of surgical proficiency on clinical outcome have not yet been established. We investigated patients with lumbar disc herniation undergoing SELD to report the clinical outcome and learning curve.Methods: Retrospective analysis of clinical outcome and learning curve were performed at a single center from clinical data collected from November 2015 to November 2018. A total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. Based on the findings that the cut-off of familiarity was 20 cases according to the cumulative study of operation time, patients were allocated to two groups: early group (n = 20) and late group (n = 62). The surgical, clinical, and radiological outcomes were retrospectively evaluated between the two groups to analyze the learning curve of SELD.Results: According to linear and log regression analyses, the operation time was obtained by the formula: operation time = 58.825 - (0.181 × [case number]) (p < 0.001). The mean operation time was significantly different between the two groups (mean 56.95 minutes; 95% confidence interval [CI], 49.12–64.78 in the early group versus mean 45.34 minutes; 95% CI, 42.45–48.22 in the late group; p = 0.008, non-parametric Mann-Whitney U test).Baseline characteristics, including demographic data, clinical factors, and findings of preoperative magnetic resonance imaging, did not differ between the two groups. Also, there was no significant difference in terms of surgical outcomes, including complication and failure rates, as well as clinical and radiological outcomes between the two groups.Conclusion: The learning curve of SELD was not as steep as that of other minimally invasive spinal surgery techniques, and the experience of surgery was not an influencing factor for outcome variation.

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