The international journal of medical robotics + computer assisted surgery : MRCAS · 2011
Robot-assisted laparoscopic management of cardia carcinoma according to Siewert recommendations.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Patriti Alberto, Ceccarelli Graziano, Ceribelli Cecilia, Bartoli Alberto, Spaziani Alessandro, Cisano Claudio, Cigliano Silvia, Casciola Luciano
Аннотация
BACKGROUND: Resection of cardia and upper gastric carcinoma is considered a demanding procedure in laparoscopic surgery. Robotics could aid laparoscopic dissection of the oesophago-gastric junction and oesophageal anastomosis, enlarging indications for a minimally invasive approach to these tumours.
METHODS: Data from 17 consecutive patients with histologically proved cardia carcinoma were collected in a prospective database to assess the feasibility and safety of laparoscopic robot-assisted radical surgery, using the four-arm da Vinci surgical system. The type of surgery was chosen according to Siewert recommendations. Outcome measures were conversion rate, intra- and post-operative morbidity and mortality, operative time, blood loss, number of lymph nodes harvested and macroscopic and microscopic evaluation of resection margins.
RESULTS: Seventeen laparoscopic operations were completed without conversion (14 extended gastrectomies, two transhiatal distal oesophagectomies and one transthoracic distal oesophagectomy). Extended lymph node dissection and oesophago-jejunal anastomosis were successfully carried out using the da Vinci system. Mean operative time was 327.2 ± 93.4 min and blood loss 279 ± 199 ml. The mean number of nodes retrieved was 28 ± 9 and all resection margins were negative. There was no mortality and overall morbidity was acceptably low (41.1%). During a mean follow-up time of 20 months, four recurrences were recorded (two multivisceral, one to the lung and one nodal), with two recurrence-related deaths.
CONCLUSIONS: Robot-assisted laparoscopic radical surgery of the oesophago-gastric junction is feasible and safe. Longer follow-up time and randomized studies are needed to evaluate the long-term outcome and advantages for the patient of this new technology.
METHODS: Data from 17 consecutive patients with histologically proved cardia carcinoma were collected in a prospective database to assess the feasibility and safety of laparoscopic robot-assisted radical surgery, using the four-arm da Vinci surgical system. The type of surgery was chosen according to Siewert recommendations. Outcome measures were conversion rate, intra- and post-operative morbidity and mortality, operative time, blood loss, number of lymph nodes harvested and macroscopic and microscopic evaluation of resection margins.
RESULTS: Seventeen laparoscopic operations were completed without conversion (14 extended gastrectomies, two transhiatal distal oesophagectomies and one transthoracic distal oesophagectomy). Extended lymph node dissection and oesophago-jejunal anastomosis were successfully carried out using the da Vinci system. Mean operative time was 327.2 ± 93.4 min and blood loss 279 ± 199 ml. The mean number of nodes retrieved was 28 ± 9 and all resection margins were negative. There was no mortality and overall morbidity was acceptably low (41.1%). During a mean follow-up time of 20 months, four recurrences were recorded (two multivisceral, one to the lung and one nodal), with two recurrence-related deaths.
CONCLUSIONS: Robot-assisted laparoscopic radical surgery of the oesophago-gastric junction is feasible and safe. Longer follow-up time and randomized studies are needed to evaluate the long-term outcome and advantages for the patient of this new technology.