The Study On Robotic Surgery And Analgesia In ERAS Program And The Possible Mechanisms

Part ⅠERAS program enhances functional recovery after robotic gastrectomy following Transvaginal Specimen ExtractionAIM:Enhance Recovery After Surgery(ERAS)program have demonstrated advantages over conventional perioperative care after gastrectomies,and robotic surgeries also have shown minimal invasive advantages in gastric cancer patients,so do the Natural Orifice Specimen Extractions;however,there is no investigation on robotic gastrectomy applied with ERAS program.This study was conducted to estimate the value of the combination of minimal invasive ERAS program and robotic surgery for gastric cancer patients.METHODS:Between July and November 2014,20 female patients who were diagnosed with gastric adenocarcinoma underwent gastrectomy.According to the patients’ will,8 of them underwent robotic gastrectomy following TVSE under the ERAS principle as the ERAS group.The other 12 received open-abdomen Gastrectomy with conventional care perioperatively were Conventional group.Duirig the 6 month following up,Postoperative hospital stay,return of gastrointestinal function,postoperative complications and 30-day re-admission were recorded.RESULTS:Postoperative hospital stay was shorter in the ERAS group,a mean duration of 3.6 days versus 6.8 days in the Conventional group(p<0.01).None was readmitted within 30 days following up except one in Conventional group for surgical site infection.During the follow-up,no stricture developed nor was any anastomotic leakage detected.No death occurred in hospital and during the follow up.CONCLUSION:When applied NOSE with robotic gastrectomy,ERAS program is feasible,safe and may lead to accelerated functional recovery and reductions in postoperative hospital stay.Part ⅡThe Effect of ERAS Program on Intestinal Microbiota in Robotic gastrectomy patientsAIM:To investigate the effect and the possible mechanism of Minimal Invasive Surgery in ERAS Program on Intestinal Microbiota in gastric cancer patients and expolore the possible mechanism.METHODS:Between October and Decmber 2015,twelve patients were enrolled in this trail,they were all dignosed of gastric cancer before they underwent gastrectomy.Six patients received robotic gastrectomy with ERAS program while the other six patient received open surgery with tranditional perioperative care.Faeces samples are deposit both before and after the surgery.These faecal samples arecollected for 16s rRNA pyrosequencing by an illumina analysis.RESULTS:There were no significant difference between the ERAS group and the Conventional Group in flora before surgeries(P>0.05).With surgical stress,the Alpha diversity of intestinal flora of bacteria species decrease in both groups.Compared to the Converntional Group,the flora changed less in ERAS Group.ERAS can to a certain extent,might be the reason of it.CONCLUSION:Compared to the Converntional Group,it is more likely to maintain the intestinal microbiota in ERAS program.Part Ⅲ The Effect of different analgesia on Intestinal barrier in a mice modelAIM:To investigate the effect and the possible mechanism of different analgesia on intestinal barrier in a mice model.METHODS:24 ICR mice were divided into three groups,8 each group.They are the control group,the morphine group and the Cox2 inhibitor group.The mice were cut open on the belly,Their Intestine were cut and then sutured when they were under ether anesthesia.After the operation,normal saline,morphine and Cox2 inhibitor were given according to their group.Sample tissues as well as blood were collected to test at 0 hour,1 hour,4 hours and 8 hours postoperatively.RESULTS:Compared with control group,morphine group and Cox2 inhibitors groups have relatively good Onccludin and ZOl.Their Chiu’s score is also higher than the control group.IL6 and TNF a level is lower in these two groups,which also consist with the benefit of analgesia for decreasing surgical trauma,stress response and postoperative inflammation control.And Cox2 inhibitor group contains more Occludin and ZOl than the morphine group.The effect of inflammation control is better than that of morphine group.IL-6 and TNF α is lower in the Cox2 inhibitor group than that of morphine group.CONCLUSION:Cox2 inhibitor can relieve the pain,reduce the damage of intestinal barrier as well as control inflammation.