Stapler-Less Robotic Partial Gastrectomy: a Safety and Feasibility Experimental Study

No true preliminary work has been performed and published on the use of the bipolar cautery devices for transection of the stomach when performed as a part of the sleeve gastrectomy or gastric wedge resection. The objective of this study was to investigate the feasibility and safety of substitution of linear surgical stapling devices for use of a bipolar electrosurgical sealing instrument in the performance of a totally robotic partial gastrectomy (TRPG).

Ten female pigs were assigned to an intervention or control group. Intervention included TRPG with a robotic bipolar tissue coagulation device. In the control group, TRPG was performed using the staplers. Assessed outcomes included presence of the intraoperative and postoperative bleeding or leak and features of the sections from the stapled line or sutured line.

Mean operating time was (130 ± 31 min) and (87 ± 23 min) in the study and control groups (p = 0.03). Intraoperative gastroscopy revealed slow bleeding associated with the staple line in 3/5 control pigs; oozing was not appreciated in any of the study pigs (0/5). No leak was detected during intraoperative gastroscopy. No major complications were suspected postoperatively or identified at postmortem exam in either group. Mean injury width was (1.12 ± 0.93 mm) in the control group with greater mean injury width (7.88 ± 3.73 mm) in the study group (p = 0.001). Mean depth of ulceration was (0.99 ± 0.94 mm) in the control group, with greater mean ulceration depth (2.25 ± 0.84 mm) in the study group (p = 0.002).

The study showed the technical feasibility of performing stapler-less gastric wedge resection. The electrocautery alone failed to demonstrate the technical feasibility which was obtained with the concomitant use of a tissue clamp and a suture.