Robotic Surgery for Gastric Cancer

Overview

Gastric cancer is the fifth most common malignancy worldwide and remains the third leading cause of cancer-related deaths globally. In this regard, minimally invasive surgical approaches like robotic gastrectomy have gained much popularity. "Robotic Gastrectomy" refers to the surgical removal of all or part of the stomach for various medical conditions (particularly cancer) using robotic instruments.

Despite the name, robotic surgery is not performed by a robot but by a surgeon who controls the device at all times. There are four types of robotic gastrectomy: Total Gastrectomy, Partial Gastrectomy, wedge gastric resection, and transgastric tumor resection. The first robotic-assisted gastrectomy was performed in 2002 in Japan. This kind of surgery is also recommended for removing gastrointestinal stromal tumors, gastric adenocarcinoma, or even rare forms of carcinoid or neuroendocrine tumors.

Alternate Name

Robotic Gastrectomy or Robot-assisted Gastrectomy

Body Location

Stomach

How is Robotic Gastrectomy performed?

A robotic-assisted Gastrectomy procedure is performed by making small incisions at four places – one at the patient’s belly button area (12mm) and three incisions (8mm) on the upper abdomen. During the procedure, the doctor sits at the console and directs the performance of the robotic arms. Similar to human hands, the robotic arms work with accurate finger movement, dexterity and wrist. Moreover, while performing the surgery, a high-definition 3D view of the organs is available to surgeons, enabling them to execute procedures like bowel connections, stapling and dissection.

Preparation of Patients for Robotic Gastrectomy

Smokers should stop smoking long before surgery and not smoke again after surgery. Smoking is associated with slower recovery time and increased risk of problems.

• If pregnant, you should inform doctors about it.
• You should inform doctors about all kinds of vitamins, herbs, drugs and other supplements you take.
• Before surgery, you should not ingest any medications for a week. (For example, aspirin, vitamin E, warfarin, ibuprofen, etc.).
• Take medication on the day of the surgery as prescribed by your doctor and that too with a small sip of water.
• You should not drink or consume anything after midnight before surgery.

Procedure Type

Minimally invasive surgery

After Gastrectomy

After the surgery, a tube remains inserted in the patient's nose, which keeps the stomach empty. The tube is removed immediately when the patient's bowels are working perfectly. Most patients feel slight discomfort from the surgery, which can be easily controlled with the help of pain medications. The patients stay for 6 to 10 days, usually in hospitals post-surgery. After discharge, the patient should start performing light activities for the first 4-6 weeks. And driving should be avoided in case one is on narcotic medications.

Advantages of Robotic Gastrectomy

• Improved postoperative outcomes for patients
• Reduced pain
• Reduced risk of infections
• Lower risk of complications
• Lesser blood loss and transfusion
• Shorter hospital stay and early starting of feed
• Faster return to normal activities
• Offers magnified views of the operative field up to 10X with immersive three-dimensional views
• Motion scaling and tremor suppression helps in precision
• Reduces fatigue of surgeons

Risks and Complications

• Bleeding
• Chances of infection
• Reaction to anesthesia: This includes severe medical responses and problems with breathing
• Risks of leakage from a connection to the intestine

Recovery post Robotic Gastrectomy

If you follow enhanced recovery after surgery (ERAS) programs as well as standard discharge criteria, you can be discharged within 72 hours of the surgery with lower complications and readmission rates. The main aim of the ERAS program is to reduce the length of hospital stay as well as surgical stress and accelerate postoperative recovery. The guidelines for the ERAS program for Gastric Cancer consist of two sections.

The first section includes general enhanced recovery items, which are similar to the guidelines for pancreaticoduodenectomy. The second section consists of procedure-specific guidelines containing eight elements: preoperative oral pharmaconutrition access, preoperative nutrition, perianastomotic drains, wound catheters, transversus abdominis plane block, nasogastric decompression, early postoperative diet and artificial nutrition.

FAQs

What are the most common procedures of robotic surgery?

• Coronary artery bypass
• Surgical removals of cancerous tissue from sensitive body parts, like nerves, vital organs, and blood vessels
• Surgical removal of the gallbladder
• Hip replacement
• Hysterectomy
• Kidney removal (total/partial)
• Transplantation of kidney

Myths and Facts about Robotic Surgeries:

Myth 1: A robot performs the surgery and the surgeons are hand-off.

Fact: Though robotic surgery is based on "artificial intelligence," it is completely guided by the hands of the surgeon. The surgeon sits at the console, directs the robotic arms' insertion into the patient's abdomen, and performs the necessary surgical steps.

Myth 2: Robotic surgery can be dangerous for the patient as the set-up can malfunction during the procedure

Fact: The robotic instrument, known as da Vinci XI robotic surgery system, is built precisely with respect to function, so there is no chance of its malfunctioning. But in case any adverse situation arises hypothetically, everything comes to a standstill, and the patient would not be harmed.

Myth 3: Robotic surgery is very costly and does not produce actual results.

Fact: Robotic surgery is costly, but it is at par with laparoscopy or open surgery. The chances of recovery are higher in the case of robotic surgery, thus, significantly lowering hospitalization and medicine costs. Moreover, this technique has additional advantages: reduced pain, reduced risk of infections, lower risk of complications, lesser blood loss and transfusion, shorter hospital stay and early starting of feed and faster return to normal activities.

Myth 4: Robotic surgery does not have much access to internal organs resulting in incomplete clearance of cancer.

Fact: The 3D high-definition view, the smaller size of the instruments and the accurate movements of the joints of the robotic arms facilitate precise and safer surgeries in cancer patients.

Myth 5: Any surgeon can perform robotic surgery.

Fact: Only a surgeon who has undergone appropriate certified training can only perform robotic surgeries.