Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan.
Langenbecks Arch Surg. 2023 May 5;408(1):179. doi: 10.1007/s00423-023-02895-4.
There are several reconstructions in distal gastrectomy for gastric cancer, and there is no clear definition regarding the method selection. The optimal reconstruction is likely to vary according to the surgical setting, and the optimal reconstruction for robotic distal gastrectomy is urgently needed. In addition, as robotic gastrectomy is getting popular, cost and operative time are pressing issues of robotic gastrectomy.
Gastrojejunostomy was planned with Billroth II reconstruction using a linear stapler arranged specifically for a robotic approach. After firing the stapler, the common insertion orifice of the stapler was closed using a 30 cm long non-absorbable barbed suture, and continuously, the afferent loop of the jejunum was lifted to the stomach with the same barbed suture. In addition, we introduced laparoscopic-assisted robotic gastrectomy, using extracorporeally inserted laparoscopic devices from the assistant port. Scissors, clips, and linear staplers were all laparoscopic tools inserted extracorporeally.
Twenty-one gastric cancer patients underwent laparoscopic-assisted robotic distal gastrectomy by Billroth II reconstruction with our modifications. There were no anastomosis-related complications such as leakage, stenosis, or bleeding. There were 2 cases of aspiration pneumonia (Clavien-Dindo grade 2), 1 case of pancreatic juice leakage (grade 3a), and 1 case of delayed gastric emptying (grade 1).
We successfully arranged Billroth II reconstruction for robotic distal gastrectomy with fewer operative and postoperative complications. Laparoscopic-assisted robotic gastrectomy using extracorporeally inserted devices, and continuous suturing using a barbed suture will reduce the time and cost of robotic gastrectomy.
胃癌远端胃切除术后有几种重建方法，对于方法选择尚无明确定义。最佳重建方式可能因手术环境而异，因此迫切需要为机器人远端胃切除术选择最佳的重建方式。此外，随着机器人胃切除术的普及，成本和手术时间成为了机器人胃切除术的紧迫问题。
使用专门为机器人手术设计的线性吻合器规划毕罗氏 II 型胃空肠吻合术。吻合器击发后，使用 30cm 长的非吸收性带刺缝线封闭吻合器的共同插入孔，并使用相同的带刺缝线将空肠的输入襻提起至胃内。此外，我们引入了腹腔镜辅助机器人胃切除术，通过辅助端口插入体外的腹腔镜设备。剪刀、夹子和线性吻合器均为体外插入的腹腔镜工具。
21 例胃癌患者接受了腹腔镜辅助机器人毕罗氏 II 型远端胃切除术和我们的改良术式，无吻合口相关并发症，如漏、狭窄或出血。有 2 例吸入性肺炎（Clavien-Dindo 分级 2），1 例胰液漏（3a 级），1 例胃排空延迟（1 级）。
我们成功地为机器人远端胃切除术安排了毕罗氏 II 型重建，手术和术后并发症较少。使用体外插入设备的腹腔镜辅助机器人胃切除术以及使用带刺缝线的连续缝合将减少机器人胃切除术的时间和成本。
