Anatomy And Assessment Of A Modified Technique During Totally Robotic Distal Gastrectomy: A Retrospective Cohort Study

Background:Robotic gastrectomy for the treatment of gastric cancer has so far had tremendous outcomes.Minimal blood loss,lower readmission rates,and increased lymph node yields constitute some remarkable benefits of robotic technology in gastric surgery.Nevertheless,refining surgical techniques,the instrument used,port placement,and even arm-positioning has not ceased.Objective:This study aims to compare the outcomes between totally robotic distal gastrectomy(TRDG)with a modified port placement and arm positioning techniques and conventional totally laparoscopic distal gastrectomy(CTLDG).Patients and Methods:Fifty-two patients were enrolled in the study following a retrospective review of an in-patient database between January 2019 and June 2020.Data on demographic,clinical data and surgical outcomes were collected,analyzed,and presented.Surgical outcomes of interest included operative time,reconstruction time,estimated blood loss,number of retrieved lymph nodes,conversion rate,length of hospital stay,days of first flatus and oral intake,and postoperative complications.Statistical analysis was performed using IBM SPSS Statistics for Windows,Version 25.0.Armonk,NY:IBM Corp.A two-sided p-value<0.05 was considered significant.Results:Nineteen patients were in the TRDG group while 33 were in the CTLDG group,with mean ages 60.42±1 1.53 and 62.94±10.2 years(p=0.418),respectively.Thirty four patients were males while 18 were females.Generally,there were no differences in demographic characteristics between the two groups(all p>0.05).There were no differences in the clinical T stages between the two groups;nonetheless,a significant difference was observed in clinical N stages between the groups(p=0.042).Patients in the laparoscopic group exhibited a significantly higher preoperative albumin level than robotic patients(p=0.000).The operative time was longer in the TRDG group(223 vs.207 min),but the difference was insignificant(p=0.220).The reconstruction time was significantly shorter for the laparoscopic group(p=0.000).Except for a significantly higher value of postoperative albumin level(p-value=0.005)in the robotic group,there were no significant differences in all other surgical outcomes between the two groups.One(5.3%)patient had a severe complication in the robotic group compared to four(12.1%)in the laparoscopic group.Nevertheless,the differences in complications were statistically insignificant.During risk factors assessment,age≥60 years and pre-operative albumin<38 g/L were determined as independent risk factors for postoperative complications following robotic and laparoscopic gastrectomy in a multivariate analysis.Otherwise,ASA score Ⅲ had an association with the development of postoperative complications after robotic and laparoscopic gastrectomy by univariate analysis;however,it had no association on multivariate analysis.Conclusion:The modified approach is a safe and feasible technique to be applied in totally robotic distal gastrectomy for the treatment of gastric cancer patients.The preliminary outcomes on measured parameter are satisfactory.However,a randomized prospective study with a larger patient accrual and longer study time frame is recommended to assess the long-term outcomes including oncologic effects of the approach on patients.