Robotic valvuloplastic esophagogastrostomy using double flap technique following proximal gastrectomy

technical aspects and short-term outcomes

Susumu Shibasaki, Koichi Suda, Masaya Nakauchi, Kenji Kikuchi, Shinichi Kadoya, Yoshinori Ishida, Kazuki Inaba, Ichiro Uyama

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Valvuloplastic esophagogastrostomy by double flap technique (VEG-DFT) is a promising procedure to prevent reflux after proximal gastrectomy (PG), and is achieved by the burial of the abdominal esophagus into the gastric submucosa; however, laparoscopic VEG-DFT is technically demanding due to complicated suturing and ligation maneuvers. The present study was designed to determine the feasibility and safety of robotic VEG-DFT. Methods: After robotic PG, seromuscular flaps were extracorporeally created at the anterior wall of the remnant stomach through a small umbilical incision. Then, using a robot, the posterior wall of the esophagus was fixed to the cranial end of the mucosal window, and layer-to-layer sutures were placed between the anterior aspects of esophagus and the remnant stomach. Finally, the anastomosis was covered by seromuscular flaps. Short-term outcomes of 12 consecutive patients who underwent VEG-DFT between January 2014 and December 2015 were assessed. Results: Operations were successfully completed using robotic assistance in all patients. Median operative, surgeon console, and anastomosis times were 406 (324–613 min), 267 (214–483), and 104 (76–186) min, respectively, and median estimated blood loss was 31 (5–130) ml. The first six cases were required to reach a learning plateau. Both mortality and morbidity rates within 30 days after surgery were 0%. Postoperative hospital stay was 10 (9–30) days. No postoperative reflux esophagitis was observed, whereas anastomotic stenosis, which required endoscopic balloon dilation, developed in three patients (25%) in postoperative month 2. There was a significant association between the total number of stitches used for VEG-DFT and anastomotic stenosis (p < 0.001). Conclusions: Robotic assistance may be useful for VEG-DFT with a short learning curve. Attention is required to prevent postoperative anastomotic stenosis possibly caused by an excessive number of stitches for esophagogastrostomy.

Original languageEnglish
Pages (from-to)1-15
Number of pages15
JournalSurgical Endoscopy and Other Interventional Techniques
DOIs
Publication statusAccepted/In press - 2017 Mar 31

Fingerprint

Robotics
Gastrectomy
Esophagus
Gastric Stump
Pathologic Constriction
Umbilicus
Burial
Peptic Esophagitis
Learning Curve
Ambulatory Surgical Procedures
Sutures
Ligation
Dilatation
Length of Stay
Stomach
Learning
Morbidity
Safety
Mortality

Keywords

  • Fundoplication
  • Gastrectomy
  • Robotic surgical procedure

ASJC Scopus subject areas

  • Surgery

Cite this

Robotic valvuloplastic esophagogastrostomy using double flap technique following proximal gastrectomy : technical aspects and short-term outcomes. / Shibasaki, Susumu; Suda, Koichi; Nakauchi, Masaya; Kikuchi, Kenji; Kadoya, Shinichi; Ishida, Yoshinori; Inaba, Kazuki; Uyama, Ichiro.

In: Surgical Endoscopy and Other Interventional Techniques, 31.03.2017, p. 1-15.

Research output: Contribution to journalArticle

Shibasaki, Susumu ; Suda, Koichi ; Nakauchi, Masaya ; Kikuchi, Kenji ; Kadoya, Shinichi ; Ishida, Yoshinori ; Inaba, Kazuki ; Uyama, Ichiro. / Robotic valvuloplastic esophagogastrostomy using double flap technique following proximal gastrectomy : technical aspects and short-term outcomes. In: Surgical Endoscopy and Other Interventional Techniques. 2017 ; pp. 1-15.
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T1 - Robotic valvuloplastic esophagogastrostomy using double flap technique following proximal gastrectomy

T2 - technical aspects and short-term outcomes

AU - Shibasaki, Susumu

AU - Suda, Koichi

AU - Nakauchi, Masaya

AU - Kikuchi, Kenji

AU - Kadoya, Shinichi

AU - Ishida, Yoshinori

AU - Inaba, Kazuki

AU - Uyama, Ichiro

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Y1 - 2017/3/31

N2 - Background: Valvuloplastic esophagogastrostomy by double flap technique (VEG-DFT) is a promising procedure to prevent reflux after proximal gastrectomy (PG), and is achieved by the burial of the abdominal esophagus into the gastric submucosa; however, laparoscopic VEG-DFT is technically demanding due to complicated suturing and ligation maneuvers. The present study was designed to determine the feasibility and safety of robotic VEG-DFT. Methods: After robotic PG, seromuscular flaps were extracorporeally created at the anterior wall of the remnant stomach through a small umbilical incision. Then, using a robot, the posterior wall of the esophagus was fixed to the cranial end of the mucosal window, and layer-to-layer sutures were placed between the anterior aspects of esophagus and the remnant stomach. Finally, the anastomosis was covered by seromuscular flaps. Short-term outcomes of 12 consecutive patients who underwent VEG-DFT between January 2014 and December 2015 were assessed. Results: Operations were successfully completed using robotic assistance in all patients. Median operative, surgeon console, and anastomosis times were 406 (324–613 min), 267 (214–483), and 104 (76–186) min, respectively, and median estimated blood loss was 31 (5–130) ml. The first six cases were required to reach a learning plateau. Both mortality and morbidity rates within 30 days after surgery were 0%. Postoperative hospital stay was 10 (9–30) days. No postoperative reflux esophagitis was observed, whereas anastomotic stenosis, which required endoscopic balloon dilation, developed in three patients (25%) in postoperative month 2. There was a significant association between the total number of stitches used for VEG-DFT and anastomotic stenosis (p < 0.001). Conclusions: Robotic assistance may be useful for VEG-DFT with a short learning curve. Attention is required to prevent postoperative anastomotic stenosis possibly caused by an excessive number of stitches for esophagogastrostomy.

AB - Background: Valvuloplastic esophagogastrostomy by double flap technique (VEG-DFT) is a promising procedure to prevent reflux after proximal gastrectomy (PG), and is achieved by the burial of the abdominal esophagus into the gastric submucosa; however, laparoscopic VEG-DFT is technically demanding due to complicated suturing and ligation maneuvers. The present study was designed to determine the feasibility and safety of robotic VEG-DFT. Methods: After robotic PG, seromuscular flaps were extracorporeally created at the anterior wall of the remnant stomach through a small umbilical incision. Then, using a robot, the posterior wall of the esophagus was fixed to the cranial end of the mucosal window, and layer-to-layer sutures were placed between the anterior aspects of esophagus and the remnant stomach. Finally, the anastomosis was covered by seromuscular flaps. Short-term outcomes of 12 consecutive patients who underwent VEG-DFT between January 2014 and December 2015 were assessed. Results: Operations were successfully completed using robotic assistance in all patients. Median operative, surgeon console, and anastomosis times were 406 (324–613 min), 267 (214–483), and 104 (76–186) min, respectively, and median estimated blood loss was 31 (5–130) ml. The first six cases were required to reach a learning plateau. Both mortality and morbidity rates within 30 days after surgery were 0%. Postoperative hospital stay was 10 (9–30) days. No postoperative reflux esophagitis was observed, whereas anastomotic stenosis, which required endoscopic balloon dilation, developed in three patients (25%) in postoperative month 2. There was a significant association between the total number of stitches used for VEG-DFT and anastomotic stenosis (p < 0.001). Conclusions: Robotic assistance may be useful for VEG-DFT with a short learning curve. Attention is required to prevent postoperative anastomotic stenosis possibly caused by an excessive number of stitches for esophagogastrostomy.

KW - Fundoplication

KW - Gastrectomy

KW - Robotic surgical procedure

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