Display options
Share it on

Asian J Endosc Surg. 2022 Jan;15(1):70-81. doi: 10.1111/ases.12967. Epub 2021 Jul 14.

The safe performance of robotic gastrectomy by second-generation surgeons meeting the operating surgeon's criteria in the Japan Society for Endoscopic Surgery guidelines.

Asian journal of endoscopic surgery

Susumu Shibasaki, Koichi Suda, Shinichi Kadoya, Yoshinori Ishida, Masaya Nakauchi, Kenichi Nakamura, Shingo Akimoto, Tsuyoshi Tanaka, Kenji Kikuchi, Kazuki Inaba, Ichiro Uyama

Affiliations

  1. Department of Surgery, Fujita Health University, Toyoake, Japan.
  2. Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University School of Medicine, Toyoake, Japan.
  3. Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kuratsuki-higashi, Kanazawa, Japan.
  4. Department of Gastroenterological Surgery, Hyogo College of Medicine, Nishinomiya, Japan.

PMID: 34263539 DOI: 10.1111/ases.12967

Abstract

BACKGROUND: Robotic gastrectomy (RG) for gastric cancer (GC) has gradually gained nationwide prominence following 2011 guidelines from the Japan Society for Endoscopic Surgery (JSES), including the surgeons' criteria and the proctor system. In this retrospective study, we examined the short-term outcomes of the initial series of RGs performed by second-generation operating surgeons trained within our institute.

METHODS: Between January 2017 and April 2020, five surgeons each performed RG in 20 patients with clinical stage III or lower GC in accordance with the JSES guidelines. We evaluated both the rate of Clavien-Dindo grade II or higher morbidities and the console time required to reach the learning plateau via cumulative summation (CUSUM) analysis.

RESULTS: We observed no mortality and 3% of morbidity following RG. Both the operative time (430 vs 387.5 min, P = 0.019) and console time (380 vs . 331.5 min, P = 0.009) were significantly shorter in the second 10 cases than in the initial 10 cases. We observed a remarkable trend in cases of distal gastrectomy (DG), in which the total operative time and console time were significantly shorter in the later cases. Our CUSUM analysis revealed that seven cases were required to achieve a learning plateau in RG when confined to DG.

CONCLUSIONS: Non-expert RG surgeons meeting the operating surgeon's criteria from the JSES who had trained under an expert RG surgeon safely performed RG in an initial 20 cases.

© 2021 Asia Endosurgery Task Force and Japan Society of Endoscopic Surgery and John Wiley & Sons Australia, Ltd.

Keywords: gastrectomy; minimally invasive procedures; robotic surgical procedure

References

  1. Suda K, Ishida Y, Kawamura Y, et al. Robot-assisted thoracoscopic lymphadenectomy along the left recurrent laryngeal nerve for esophageal squamous cell carcinoma in the prone position: technical report and short-term outcomes. World J Surg. 2012;36:1608-1616. - PubMed
  2. Suda K, Man IM, Ishida Y, Kawamura Y, Satoh S, Uyama I. Potential advantages of robotic radical gastrectomy for gastric adenocarcinoma in comparison with conventional laparoscopic approach: a single institutional retrospective comparative cohort study. Surg Endosc. 2015;29:673-685. - PubMed
  3. Uyama I, Kanaya S, Ishida Y, Inaba K, Suda K, Satoh S. Novel integrated robotic approach for suprapancreatic D2 nodal dissection for treating gastric cancer: technique and initial experience. World J Surg. 2012;36:331-337. - PubMed
  4. Shibasaki S, Suda K, Obama K, Yoshida M, Uyama I. Should robotic gastrectomy become a standard surgical treatment option for gastric cancer? Surg Today. 2020;50:955-965. - PubMed
  5. Uyama I, Suda K, Nakauchi M, et al. Clinical advantages of robotic gastrectomy for clinical stage I/II gastric cancer: a multi-institutional prospective single-arm study. Gastric Cancer. 2019;22:377-385. - PubMed
  6. Okabe H, Obama K, Tsunoda S, et al. Feasibility of robotic radical gastrectomy using a monopolar device for gastric cancer. Surg Today. 2019;49:820-827. - PubMed
  7. Tokunaga M, Makuuchi R, Miki Y, et al. Late phase II study of robot-assisted gastrectomy with nodal dissection for clinical stage I gastric cancer. Surg Endosc. 2016;30:3362-3367. - PubMed
  8. Kim HI, Han SU, Yang HK, et al. Multicenter prospective comparative study of robotic versus laparoscopic gastrectomy for gastric adenocarcinoma. Ann Surg. 2016;263:103-109. - PubMed
  9. Shibasaki S, Suda K, Nakauchi M, et al. Non-robotic minimally invasive gastrectomy as an independent risk factor for postoperative intra-abdominal infectious complications: a single-center, retrospective and propensity score-matched analysis. World J Gastroenterol. 2020;26:1172-1184. - PubMed
  10. Nakauchi M, Suda K, Susumu S, et al. Comparison of the long-term outcomes of robotic radical gastrectomy for gastric cancer and conventional laparoscopic approach: a single institutional retrospective cohort study. Surg Endosc. 2016;30:5444-5452. - PubMed
  11. Shibasaki S, Suda K, Nakauchi M, et al. Impact of the endoscopic surgical skill qualification system on the safety of laparoscopic gastrectomy for gastric cancer. Surg Endosc. 2020. https://doi.org/10.1007/s00464-020-08102-5. Epub 2020 Oct 22. - PubMed
  12. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. 2021;24:1-21. - PubMed
  13. Shinohara T, Satoh S, Kanaya S, et al. Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: a retrospective cohort study. Surg Endosc. 2013;27:286-294. - PubMed
  14. Shibasaki S, Suda K, Nakauchi M, et al. Outermost layer-oriented medial approach for infrapyloric nodal dissection in laparoscopic distal gastrectomy. Surg Endosc. 2018;32:2137-2148. - PubMed
  15. Nakamura K, Suda K, Suzuki A, et al. Intracorporeal isosceles right triangle-shaped anastomosis in totally laparoscopic distal gastrectomy. Surg Laparosc Endosc Percutan Tech. 2018;28:193-201. - PubMed
  16. Nakamura K, Suda K, Shibasaki S, et al. The hepatic left lateral segment inverting method offering a wider operative field of view during laparoscopic proximal gastrectomy. J Gastrointest Surg. 2020;24:2395-2403. - PubMed
  17. Mori T, Kimura T, Kitajima M. Skill accreditation system for laparoscopic gastroenterologic surgeons in Japan. Minim Invasive Ther Allied Technol. 2010;19:18-23. - PubMed
  18. Thiel W. The preservation of the whole corpse with natural color. Ann Anat. 1992;174:185-195. - PubMed
  19. Suda K, Nakauchi M, Inaba K, Ishida Y, Uyama I. Minimally invasive surgery for upper gastrointestinal cancer: our experience and review of the literature. World J Gastroenterol. 2016;22:4626-4637. - PubMed
  20. Shibasaki S, Suda K, Nakauchi M, et al. Robotic valvuloplastic esophagogastrostomy using double flap technique following proximal gastrectomy: technical aspects and short-term outcomes. Surg Endosc. 2017;31:4283-4297. - PubMed
  21. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-213. - PubMed
  22. Katayama H, Kurokawa Y, Nakamura K, et al. Extended Clavien-Dindo classification of surgical complications: Japan clinical oncology group postoperative complications criteria. Surg Today. 2016;46:668-685. - PubMed
  23. Kuroda S, Kikuchi S, Hori N, et al. Training system for laparoscopy-assisted distal gastrectomy. Surg Today. 2017;47:802-809. - PubMed
  24. Yamada T, Kumazu Y, Nakazono M, et al. Feasibility and safety of laparoscopy-assisted distal gastrectomy performed by trainees supervised by an experienced qualified surgeon. Surg Endosc. 2020;34:429-435. - PubMed
  25. Kameda C, Watanabe M, Suehara N, et al. Safety of laparoscopic distal gastrectomy for gastric cancer when performed by trainee surgeons with little experience in performing open gastrectomy. Surg Today. 2018;48:211-216. - PubMed
  26. Tanigawa N, Lee SW, Kimura T, et al. The endoscopic surgical skill qualification system for gastric surgery in Japan. Asian J Endosc Surg. 2011;4:112-115. - PubMed
  27. Park SS, Kim MC, Park MS, Hyung WJ. Rapid adaptation of robotic gastrectomy for gastric cancer by experienced laparoscopic surgeons. Surg Endosc. 2012;26:60-67. - PubMed
  28. Kim HI, Park MS, Song KJ, Woo Y, Hyung WJ. Rapid and safe learning of robotic gastrectomy for gastric cancer: multidimensional analysis in a comparison with laparoscopic gastrectomy. Eur J Surg. 2014;40:1346-1354. - PubMed
  29. Zhou J, Shi Y, Qian F, et al. Cumulative summation analysis of learning curve for robot-assisted gastrectomy in gastric cancer. J Surg Oncol. 2015;111:760-767. - PubMed
  30. Mariani A, Pellegrini E, De Momi E. Skill-oriented and performance driven adaptive curricula for training in robot-assisted surgery using simulators: a feasibility study. IEEE Trans Biomed Eng. 2021;68:685-694. - PubMed
  31. Stava RM, Stefanidis D, Levy JS, et al. Proving the effectiveness of the fundamentals of robotic surgery (FRS) skills curriculum: a single-blinded, multispecialty, multi-institutional randomized control trial. Ann Surg. 2020;272:384-392. - PubMed
  32. Nunobe S, Hiki N, Tanimura S, Nohara K, Sano T, Yamaguchi T. The clinical safety of performing laparoscopic gastrectomy for gastric cancer by trainees after sufficient experience in assisting. World J Surg. 2013;37:424-429. - PubMed
  33. Gotoh M, Miyata H, Hashimoto H, et al. National Clinical Database feedback implementation for quality improvement of cancer treatment in Japan: from good to great through transparency. Surg Today. 2016;46:38-47. - PubMed

MeSH terms

Publication Types