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Robotic Total Gastrectomy Pricier, but Has Advantages Over Laparoscopic Approach

NEW YORK (Reuters Health) – In experienced hands, robotic total gastrectomy has advantages for the surgeon and patient, but is costlier than traditional laparoscopic surgery, according to a study from China.

The study showed that “in complex, minimally invasive gastric cancer (GC) surgery, the robotic system could provide experienced surgeons at high-volume specialized institutions with a more precise operating environment and reduce surgical burden,” report Dr. Qi-Yue Chen and colleagues from Fujian Medical University Union Hospital in Fuzhou.

Further, they say robotic surgery provides patients with a radical treatment that is not inferior to laparoscopic surgery and with faster postoperative recovery.

“Development of robotic systems in radical gastrectomy may promote reciprocity for patients and experienced surgeons,” they conclude.

The impact of robotic systems on total gastrectomy remains uncertain, the clinicians point out. They compared short-term outcomes, surgery burden, and technical performance of robotic total gastrectomy (RTG) and laparoscopic total gastrectomy (LTG) for GC.

Their prospective study included 48 patients with advanced proximal GC who underwent RTG (using the da Vinci Si robotic system) between 2018 and 2020 and a propensity-score-matched group of 96 patients who underwent LTG.

RTG was associated with less intraoperative blood loss than LTG (39 vs. 66 mL, P=0.042) and retrevial of significantly more extraperigastric lymph nodes (20.2 vs. 17.5, P=0.039), the researchers report.

There were no significant difference in the RTG and LTG group in terms of postoperative complications (15% vs. 17%, P=0.75) or severity (P=0.912).

For the overall surgery, the average number of errors was lower with RTG than LTG (43 vs. 54 times/case, P<0.001). The average number of adverse events (22 vs. 23 times/case, P=0.20) and average number of rectifications (13 vs. 14 times/case, P=0.8) were comparable between the groups.

Compared with LTG, RTG had a higher technical skill score (30 vs. 28, P<0.001) and a lower surgery-task-load index (33 vs. 40, P<0.001). With RTG, surgeons reported significantly lower situational stress (P=0.011), task complexity (P=0.048), and physical demands (P<0.001), the researchers says.

A cost analysis showed that RTG was associated with higher total mean cost ($13,743 vs. $10,971; P<0.001) and total indirect mean cost ($5,229 vs. $1,129; P<0.001) than LTG, but lower total direct cost ($8,513 vs. $9,841; P<0.001).

“To the best of our knowledge, this is the first prospective study comparing surgical outcome, technical performance, and surgical burden of robotic and LG for patients with GC,” the authors say.

By way of limitations, they note that the study included only patients from a single center and data on long-term outcomes were unavailable. In addition, all surgical procedures were performed by senior general surgeons and the results might be different with surgeons at different experience levels.

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The study had no commercial funding and the authors report no conflicts of interest.

SOURCE: https://bit.ly/3roxpFR Annals of Surgery, online January 22, 2021.

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