Parisi A, Ricci F, Gemini A, Trastulli S, Cirocchi R, Palazzini G, D’Andrea V, Desiderio J. New totally intracorporeal reconstructive approach after robotic total gastrectomy: Technical details and short-term outcomes. World J Gastroenterol 2017; 23(23): 4293-4302 [PMID: 28694670 DOI: 10.3748/wjg.v23.i23.4293]
Corresponding Author of This Article
Jacopo Desiderio, MD, Department of Digestive Surgery, St. Mary’s Hospital of Terni, University of Perugia, Via Tristano di Joannuccio 1, 05100 Terni, Italy. jacopo.desiderio@studenti.unipg.it
Research Domain of This Article
Allergy
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jun 21, 2017; 23(23): 4293-4302 Published online Jun 21, 2017. doi: 10.3748/wjg.v23.i23.4293
New totally intracorporeal reconstructive approach after robotic total gastrectomy: Technical details and short-term outcomes
Amilcare Parisi, Francesco Ricci, Alessandro Gemini, Stefano Trastulli, Roberto Cirocchi, Giorgio Palazzini, Vito D’Andrea, Jacopo Desiderio
Amilcare Parisi, Francesco Ricci, Alessandro Gemini, Stefano Trastulli, Roberto Cirocchi, Jacopo Desiderio, Department of Digestive Surgery, St. Mary’s Hospital of Terni, University of Perugia, 05100 Terni, Italy
Roberto Cirocchi, Department of General Surgery, St. Mary's Hospital of Terni, University of Perugia, 05100 Terni, Italy
Giorgio Palazzini, Vito D’Andrea, Department of Surgical Science, “La Sapienza” University, 00185 Rome, Italy
Author contributions: Parisi A and Desiderio J were involved in study conception and design; Parisi A, Ricci F, Gemini A, Trastulli S, Cirocchi R, Palazzini G, D’Andrea V and Desiderio J collected data and were involved in critical revision and drafting of the final manuscript.
Institutional review board statement: The study was approved by the region ethics committee (CEAS Umbria).
Informed consent statement: Not required for the present study.
Conflict-of-interest statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Data sharing statement: Technical appendix available from the corresponding author at djdesi85@hotmail.it.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jacopo Desiderio, MD, Department of Digestive Surgery, St. Mary’s Hospital of Terni, University of Perugia, Via Tristano di Joannuccio 1, 05100 Terni, Italy. jacopo.desiderio@studenti.unipg.it
Telephone: +39-349-7531121 Fax: +39-744-205078
Received: January 25, 2017 Peer-review started: February 1, 2017 First decision: March 3, 2017 Revised: March 31, 2017 Accepted: May 9, 2017 Article in press: May 9, 2017 Published online: June 21, 2017 Processing time: 146 Days and 6 Hours
Abstract
AIM
To show outcomes of our series of patients that underwent a total gastrectomy with a robotic approach and highlight the technical details of a proposed solution for the reconstruction phase.
METHODS
Data of gastrectomies performed from May 2014 to October 2016, were extracted and analyzed. Basic characteristics of patients, surgical and clinical outcomes were reported. The technique for reconstruction (Parisi Technique) consists on a loop of bowel shifted up antecolic to directly perform the esophago-enteric anastomosis followed by a second loop, measured up to 40 cm starting from the esojejunostomy, fixed to the biliary limb to create an enteroenteric anastomosis. The continuity between the two anastomoses is interrupted just firing a linear stapler, so obtaining the Roux-en-Y by avoiding to interrupt the mesentery.
RESULTS
Fifty-five patients were considered in the present analysis. Estimated blood loss was 126.55 ± 73 mL, no conversions to open surgery occurred, R0 resections were obtained in all cases. Hospital stay was 5 (3-17) d, no anastomotic leakage occurred. Overall, a fast functional recovery was shown with a median of 3 (3-6) d in starting a solid diet.
CONCLUSION
Robotic surgery and the adoption of a tailored reconstruction technique have increased the feasibility and safety of a minimally invasive approach for total gastrectomy. The present series of patients shows its implementation in a western center with satisfying short-term outcomes.
Core tip: Minimally invasive surgery is growing interest for gastric cancer. Technology has allowed to increase the safety and feasibility of this approach, even in demanding procedures. Total gastrectomy represents a challenge in this context due to the need to ensure a safe esophagojejunal anastomosis. Leakages can strongly influence the postoperative course of the patient until lead to serious consequences.
