Abstract:
Objective : To introduce a programmed “seven-step method” in remote radical gastrectomy with Da Vinci robot “3+2”mode.
Method : This retrospective analysis included 100 patients who underwent Da Vinci robotic distal gastrectomy at Gansu Provincial Hospital from June 2017 to June 2020. The surgery was performed in seven steps: 1) docking, abdominal exploration, hanging the liver, posing, and connecting machine; 2) right side of the greater curvature of the stomach and inferior pylorus area (4d, 6); 3) superior pyloric region, detaching the duodenum, and clearing the hepatoduodenal ligament (5, 12a); 4) anterior region of the pancreas (7, 8a, 8p, 9, 11p); 5) small curvature area of the stomach (1, 3); 6) left side of the greater curvature of the stomach (4sb); and 7) dissecting the stomach specimen and anastomosis of the proximal stomach and jejunum.
Results : All patients did not have surgical conversion or blood transfusion during the operation. The operation time was (175.0±16) min, bleeding amount was (99±36.4) mL, number of lymph node dissection was (30.3±2.5), and cost of the Da Vinci system was (22, 794±3, 660) Yuan. Complications occurred in five cases: two cases of intestinal obstruction, one of intraperitoneal hemorrhage, one of wound infection, and one of delayed gastric emptying. All cases were cured following conservative methods. No anastomotic stenosis or anastomotic fistula was noted.
Conclusions : This model method is safe, feasible, and reproducible and has a short operation time and low cost. The patterning method is beneficial for training operation teams, shortening learning curves, and reducing operation difficulty to better serve clinical teaching.