Zheng H L, Lin J, Huang C M
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2022 May 25;25(5):392-395. doi: 10.3760/cma.j.cn441530-20220304-00083.
There still remain some problemsin digestive tract reconstruction after robotic radical gastrectomy for gastric cancer at present, such as great surgical difficulties and high technical requirements. Based on the surgical experience of the Gastric Surgery Department of Union Hospital, Fujian Medical University and the literatures at home and abroad, relevant issues are discussed in terms of robotic radical distal gastrectomy (Billroth I, Billroth II, and Roux-en-Y gastrojejunostomy), proximal gastrectomy (double-channel and double-muscle flap anastomosis), and total gastrectomy (Roux-en-Y anastomosis, functional end-to-end anastomosis, FEEA, π-anastomosis, Overlap anastomosis, and modified Overlap anastomosis with delayed amputation of jejunum, i.e. later-cut Overlap). This article mainly includes (1) The principles of digestive tract reconstruction after robotic radical gastrectomy for gastric cancer. (2) Digestive tract reconstruction after robotic radical distal gastrectomy: Aiming at the weakness of traditional triangular anastomosis, we introduce the improvement of the technical difficulty, namely "modified triangular anastomosis", and point out that because Billroth II anastomosis is a common anastomosis method in China at present, manual suture under robot is more convenient and safe, and can effectively avoid anastomotic stenosis. (3) Digestive tract reconstruction after robotic proximal gastrectomy: It mainly includes double channel anastomosis and double muscle flap anastomosis, but these reconstruction methods are relatively complicated, and robotic surgery has not been widely carried out at present. (4) Digestive tract reconstruction after robotic total gastrectomy: The most classic one is Roux-en-Y anastomosis, mainly using circular stapler for end-to-side esophagojejunal anastomosis and linear stapler for side-to-side esophagojejunal anastomosis, for which we discuss the solutions to the existing technical difficulties. With the continuous innovation of robotic surgical system and anastomosis instruments, and with the gradual improvement of anastomosis technology, it is believed that digestive tract reconstruction after robotic radical gastrectomy for gastric cancer will have a good application prospect in gastric cancer surgery.
目前，机器人胃癌根治术后消化道重建仍存在一些问题，如手术难度大、技术要求高。基于福建医科大学附属协和医院胃外科的手术经验及国内外文献，从机器人根治性远端胃切除术（毕Ⅰ式、毕Ⅱ式和Roux-en-Y胃空肠吻合术）、近端胃切除术（双通道和双肌瓣吻合术）以及全胃切除术（Roux-en-Y吻合术、功能性端端吻合术、FEEA、π吻合术、重叠吻合术以及改良重叠吻合术并延迟空肠断端切除，即后切重叠）等方面对相关问题进行探讨。本文主要包括：（1）机器人胃癌根治术后消化道重建的原则。（2）机器人根治性远端胃切除术后的消化道重建：针对传统三角吻合的不足，介绍技术难度的改进，即“改良三角吻合”，并指出由于毕Ⅱ式吻合是目前国内常用的吻合方式，机器人辅助下手工缝合更简便安全，可有效避免吻合口狭窄。（3）机器人近端胃切除术后的消化道重建：主要包括双通道吻合和双肌瓣吻合，但这些重建方式相对复杂，目前机器人手术尚未广泛开展。（4）机器人全胃切除术后的消化道重建：最经典的是Roux-en-Y吻合术，主要采用圆形吻合器进行食管空肠端侧吻合，线性吻合器进行食管空肠侧侧吻合，对此讨论了现有技术难点的解决方法。随着机器人手术系统和吻合器械的不断创新，以及吻合技术的逐步提高，相信机器人胃癌根治术后消化道重建在胃癌手术中会有良好的应用前景。
