Despite the increasing application of robotic surgery in patients with gastric cancer, however, for the complex minimally invasive total gastrectomy, no reports are supporting robotic surgery that can improve surgical performance and clinical outcomes.
In this prospective study, 50 patients were assigned to underwent robotic total gastrectomy (RTG) between March 2018 to February 2020 at a tertiary referral teaching hospital. Patients who underwent laparoscopic total gastrectomy (LTG) in the FUGES-002 study were matched to compare the surgical outcome and surgery task load of RTG and LTG. Objective structured assessment of technical skill (OSATS) was used to evaluate the technical performance.
After propensity score matching, 48 patients in the RTG group and 96 patients in the LTG group were included in the analysis. The total operative time in the RTG group was longer than that in LTG Group (217.1 minutes vs. 186.1 minutes, P < 0.001). Compared with LTG, the RTG group had less intraoperative blood loss (66.4 ml vs. 38.7 ml, P = 0.042). The average number of errors in the RTG group was 43.2 times/case, which was less than 53.8 times/case in the LTG Group (P < 0.001). Compared with LTG, RTG had a higher OSATS score (30.2 vs. 28.4, P < 0.001). RTG is superior to LTG in terms of respect for tissue, time and motion, instrument handling, and knowledge of specific procedures. The mean number of lymph nodes (LNs) retrieved in the RTG group and LTG group was 47.9 and 44.0, respectively. Significantly more extraperigastric LNs were retrieved in the RTG group than in the LTG group (20.2 vs. 17.5, P = 0.039). RTG group had a lower Surg-TLX score than LTG Group (33.2 vs. 39.8, P < 0.001). The postoperative recovery processes in the RTG group were shorter than those in the LTG Group. No significant difference was found between the RG and LG groups in the incidence (14.6% vs 16.7%, P = .86) or severity of complications.
In the complex radical gastrectomy, compared with traditional laparoscopic surgery, the use of the robotic system provides a technically superior operative environment and lower surgeon workload for minimally invasive surgery.
Scientific and Technological Innovation Joint Capital Projects of Fujian Province.
All authors have declared no conflicts of interest.