Surgical endoscopy · 2025
Robotic esophageal reconstruction with a diagonal stapling technique: technical description and early outcomes from a single-center series.
СтатьяVideo-Audio MediaНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Ushimaru Yuki, Yamamoto Kazuyoshi, Kawabata Ryohei, Yanagimoto Yoshitomo, Odagiri Kazuki, Takeoka Tomohira, Masuike Yasunori, Yamamoto Kei, Matsuura Norihiro, Sugase Takahito, Kanemura Takashi, Mori Ryota, Kitakaze Masatoshi, Amisaki Masataka, Kubo Masahiko, Fukuda Yasunari, Komatsu Hisateru, Miyo Masaaki, Sueda Toshinori, Kagawa Yoshinori, Gotoh Kunihito, Kobayashi Shogo, Miyata Hiroshi
Аннотация
BACKGROUND: Esophageal reconstruction after total or proximal gastrectomy is technically demanding. Robotic platforms provide enhanced dexterity, yet anastomotic protocols vary widely. We developed a unified, geometry-driven robotic technique-applicable to both total and proximal gastrectomy-that creates a wide V-shaped anastomosis by extending and rotating a right-anterior esophageal flap to maximize perfusion and minimize axial tension.
METHODS: Between March 2021 and May 2025, 41 patients underwent robotic gastrectomy using our "diagonal V-geometry" reconstruction: 18 proximal gastrectomies with esophagogastrostomy and 23 total gastrectomies with esophagojejunostomy. A multi-arm surgical robot with 3D visualization and articulating instruments was used. The muscularis was divided directly; the mucosa was incised over a nasogastric tube to avoid contralateral injury. Traction sutures rotated the flap posteriorly, widening the staple line interface. A powered linear stapler created a 40-45-mm V-shaped anastomosis to either the gastric remnant or Roux limb. The enterotomy was closed with a 60-mm staple line. In proximal gastrectomy, a partial Toupet fundoplication was added. Leak tests confirmed integrity. Barbed sutures secured fixation.
RESULTS: Median age was 73 years (proximal) and 77 years (total); median BMI was 21.6 and 21.2 kg/m2. D2 lymphadenectomy was performed in most patients (88.9% in PG; 100% in TG). Median operative time was 428 min (proximal) and 400 min (total). Blood loss was minimal (median 0 mL). One non-anastomotic complication occurred (5.6%) in the proximal group; none in the total group. Critically, no anastomotic leaks, strictures, or reoperations occurred. Imaging confirmed wide lumens; patients resumed oral intake without dysphagia. Three-month follow-up showed no reflux.
CONCLUSIONS: Our unified robotic diagonal V-geometry technique yielded zero leaks or strictures in 41 gastrectomies. By rotating the right-anterior flap to create a broad V-shaped staple line, perfusion is preserved and tension minimized. Larger multicenter studies are needed to confirm these promising outcomes.
METHODS: Between March 2021 and May 2025, 41 patients underwent robotic gastrectomy using our "diagonal V-geometry" reconstruction: 18 proximal gastrectomies with esophagogastrostomy and 23 total gastrectomies with esophagojejunostomy. A multi-arm surgical robot with 3D visualization and articulating instruments was used. The muscularis was divided directly; the mucosa was incised over a nasogastric tube to avoid contralateral injury. Traction sutures rotated the flap posteriorly, widening the staple line interface. A powered linear stapler created a 40-45-mm V-shaped anastomosis to either the gastric remnant or Roux limb. The enterotomy was closed with a 60-mm staple line. In proximal gastrectomy, a partial Toupet fundoplication was added. Leak tests confirmed integrity. Barbed sutures secured fixation.
RESULTS: Median age was 73 years (proximal) and 77 years (total); median BMI was 21.6 and 21.2 kg/m2. D2 lymphadenectomy was performed in most patients (88.9% in PG; 100% in TG). Median operative time was 428 min (proximal) and 400 min (total). Blood loss was minimal (median 0 mL). One non-anastomotic complication occurred (5.6%) in the proximal group; none in the total group. Critically, no anastomotic leaks, strictures, or reoperations occurred. Imaging confirmed wide lumens; patients resumed oral intake without dysphagia. Three-month follow-up showed no reflux.
CONCLUSIONS: Our unified robotic diagonal V-geometry technique yielded zero leaks or strictures in 41 gastrectomies. By rotating the right-anterior flap to create a broad V-shaped staple line, perfusion is preserved and tension minimized. Larger multicenter studies are needed to confirm these promising outcomes.