Trans-Umbilical Lymphadenectomy Using an Articulating Bipolar Vessel-Sealing Device (TULAB) during Robotic Surgery for Gastric Cancer: Enhancing the Surgeon’s Eye for Reduced-Port Robotic Gastrectomy
Background: Docking the scope and instruments through a multi-channel trocar has enabled reduced-port robotic distal gastrectomy (RRDG) for gastric cancer. To facilitate lymphadenectomy over the anatomical hindrances during RRDG, we recently introduced the Vessel Sealer Extend<sup>®</sup>...
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MDPI AG
2023-11-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/22/5371 |
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| author | Raeyoon Jeong Min-Se Kim Chang-Min Lee In-Young Lee Sungsoo Park Seong-Heum Park |
| author_facet | Raeyoon Jeong Min-Se Kim Chang-Min Lee In-Young Lee Sungsoo Park Seong-Heum Park |
| author_sort | Raeyoon Jeong |
| collection | DOAJ |
| description | Background: Docking the scope and instruments through a multi-channel trocar has enabled reduced-port robotic distal gastrectomy (RRDG) for gastric cancer. To facilitate lymphadenectomy over the anatomical hindrances during RRDG, we recently introduced the Vessel Sealer Extend<sup>®</sup> (VSE) (Intuitive Surgical, Sunnyvale, CA, USA), a bipolar vessel-sealing device (BVSD) with an articulating jaw. Methods: From May 2020 to August 2023, we performed RRDG to treat T1 gastric cancer. One endoscope arm and three instrument arms of the da Vinci<sup>®</sup> Xi Surgical System (Intuitive Surgical) were used. During the lymphadenectomy, the endoscope and VSE (Intuitive Surgical) were docked through a multi-channel trocar established on a trans-umbilical incision. Two Cardiere forceps were docked through cannulas established on each flank. A trans-umbilical lymphadenectomy using an articulating BVSD (TULAB) was then performed. Results: A total of 42 patients underwent planned RRDG with the TULAB technique. The number of retrieved lymph nodes did not differ between the patients who underwent RRDG and those who underwent conventional laparoscopic distal gastrectomies (CLDG) (<i>p</i> = 0.362). There was no statistically significant difference in postoperative complications between the RRDG and CLDG group (<i>p</i> = 0.189). The mean time to first semi-fluid diet was shorter in the patients who underwent RRDG than CLDG (<i>p</i> = 0.030), and the incidence of postoperative ileus was lower in the RRDG group than the CLDG group (0% and 9.9%, respectively, <i>p</i> = 0.034). Conclusions: Despite use of fewer ports, RRDG with TULAB had similar outcomes to CLDG in terms of the incidence of postoperative morbidity and the number of harvested lymph nodes. Furthermore, by reducing the number of incisions, the incidence of the intra-abdominal adhesions can potentially be lowered when RRDG is used. |
| first_indexed | 2024-03-09T16:56:19Z |
| format | Article |
| id | doaj.art-0d71d98d336c4f8884a9d277733624cf |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-09T16:56:19Z |
| publishDate | 2023-11-01 |
| publisher | MDPI AG |
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| series | Cancers |
| spelling | doaj.art-0d71d98d336c4f8884a9d277733624cf2023-11-24T14:34:08ZengMDPI AGCancers2072-66942023-11-011522537110.3390/cancers15225371Trans-Umbilical Lymphadenectomy Using an Articulating Bipolar Vessel-Sealing Device (TULAB) during Robotic Surgery for Gastric Cancer: Enhancing the Surgeon’s Eye for Reduced-Port Robotic GastrectomyRaeyoon Jeong0Min-Se Kim1Chang-Min Lee2In-Young Lee3Sungsoo Park4Seong-Heum Park5Department of Surgery, Korea University College of Medicine, Seoul 02841, Republic of KoreaDepartment of Surgery, Korea University College of Medicine, Seoul 02841, Republic of KoreaDepartment of Surgery, Korea University College of Medicine, Seoul 02841, Republic of KoreaDepartment of Surgery, Korea University College of Medicine, Seoul 02841, Republic of KoreaDepartment of Surgery, Korea University College of Medicine, Seoul 02841, Republic of KoreaDepartment of Surgery, Korea University College of Medicine, Seoul 02841, Republic of KoreaBackground: Docking the scope and instruments through a multi-channel trocar has enabled reduced-port robotic distal gastrectomy (RRDG) for gastric cancer. To facilitate lymphadenectomy over the anatomical hindrances during RRDG, we recently introduced the Vessel Sealer Extend<sup>®</sup> (VSE) (Intuitive Surgical, Sunnyvale, CA, USA), a bipolar vessel-sealing device (BVSD) with an articulating jaw. Methods: From May 2020 to August 2023, we performed RRDG to treat T1 gastric cancer. One endoscope arm and three instrument arms of the da Vinci<sup>®</sup> Xi Surgical System (Intuitive Surgical) were used. During the lymphadenectomy, the endoscope and VSE (Intuitive Surgical) were docked through a multi-channel trocar established on a trans-umbilical incision. Two Cardiere forceps were docked through cannulas established on each flank. A trans-umbilical lymphadenectomy using an articulating BVSD (TULAB) was then performed. Results: A total of 42 patients underwent planned RRDG with the TULAB technique. The number of retrieved lymph nodes did not differ between the patients who underwent RRDG and those who underwent conventional laparoscopic distal gastrectomies (CLDG) (<i>p</i> = 0.362). There was no statistically significant difference in postoperative complications between the RRDG and CLDG group (<i>p</i> = 0.189). The mean time to first semi-fluid diet was shorter in the patients who underwent RRDG than CLDG (<i>p</i> = 0.030), and the incidence of postoperative ileus was lower in the RRDG group than the CLDG group (0% and 9.9%, respectively, <i>p</i> = 0.034). Conclusions: Despite use of fewer ports, RRDG with TULAB had similar outcomes to CLDG in terms of the incidence of postoperative morbidity and the number of harvested lymph nodes. Furthermore, by reducing the number of incisions, the incidence of the intra-abdominal adhesions can potentially be lowered when RRDG is used.https://www.mdpi.com/2072-6694/15/22/5371gastric cancerreduced-port robotic distal gastrectomy (RRDG)Vessel Sealer Extend<sup>®</sup> (VSE)trans-umbilical lymphadenectomy using an articulating BVSD (TULAB) |
| spellingShingle | Raeyoon Jeong Min-Se Kim Chang-Min Lee In-Young Lee Sungsoo Park Seong-Heum Park Trans-Umbilical Lymphadenectomy Using an Articulating Bipolar Vessel-Sealing Device (TULAB) during Robotic Surgery for Gastric Cancer: Enhancing the Surgeon’s Eye for Reduced-Port Robotic Gastrectomy Cancers gastric cancer reduced-port robotic distal gastrectomy (RRDG) Vessel Sealer Extend<sup>®</sup> (VSE) trans-umbilical lymphadenectomy using an articulating BVSD (TULAB) |
| title | Trans-Umbilical Lymphadenectomy Using an Articulating Bipolar Vessel-Sealing Device (TULAB) during Robotic Surgery for Gastric Cancer: Enhancing the Surgeon’s Eye for Reduced-Port Robotic Gastrectomy |
| title_full | Trans-Umbilical Lymphadenectomy Using an Articulating Bipolar Vessel-Sealing Device (TULAB) during Robotic Surgery for Gastric Cancer: Enhancing the Surgeon’s Eye for Reduced-Port Robotic Gastrectomy |
| title_fullStr | Trans-Umbilical Lymphadenectomy Using an Articulating Bipolar Vessel-Sealing Device (TULAB) during Robotic Surgery for Gastric Cancer: Enhancing the Surgeon’s Eye for Reduced-Port Robotic Gastrectomy |
| title_full_unstemmed | Trans-Umbilical Lymphadenectomy Using an Articulating Bipolar Vessel-Sealing Device (TULAB) during Robotic Surgery for Gastric Cancer: Enhancing the Surgeon’s Eye for Reduced-Port Robotic Gastrectomy |
| title_short | Trans-Umbilical Lymphadenectomy Using an Articulating Bipolar Vessel-Sealing Device (TULAB) during Robotic Surgery for Gastric Cancer: Enhancing the Surgeon’s Eye for Reduced-Port Robotic Gastrectomy |
| title_sort | trans umbilical lymphadenectomy using an articulating bipolar vessel sealing device tulab during robotic surgery for gastric cancer enhancing the surgeon s eye for reduced port robotic gastrectomy |
| topic | gastric cancer reduced-port robotic distal gastrectomy (RRDG) Vessel Sealer Extend<sup>®</sup> (VSE) trans-umbilical lymphadenectomy using an articulating BVSD (TULAB) |
| url | https://www.mdpi.com/2072-6694/15/22/5371 |
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