Totally robotic proximal gastrectomy with esophagogastrostomy using a double-flap technique

Area of Science:

• Surgical Oncology
• Gastroenterology
• Robotic Surgery

Background:

• Proximal gastrectomy (PG) with D1+ lymphadenectomy and anti-reflux reconstruction is standard for early gastric cancer (EGC) in the East.
• The double-flap technique (DFT) is an optimal anti-reflux method after PG but is technically challenging.
• Its adoption in Western countries is limited due to perceived difficulty.

Purpose of the Study:

• To present the technique of robotic proximal gastrectomy with D1+ lymphadenectomy and DFT.
• To demonstrate the feasibility of this complex procedure in a Western surgical context.
• To report outcomes in a patient undergoing this robotic procedure.

Main Methods:

• A totally robotic approach (da Vinci Xi Surgical System) was used for PG with D1+ lymphadenectomy and DFT.
• Standardized surgical steps including lymphadenectomy, esophageal transection, gastrectomy, and anastomosis with DFT were performed.
• The procedure was adapted from techniques learned in Japan.

Main Results:

• The robotic PG with DFT was successfully performed on a patient with pT1b R1 EGC.
• Postoperative pathology confirmed the absence of residual disease with 27 lymph nodes examined.
• One-year follow-up showed the patient was disease-free with no reflux esophagitis, weight loss, or anastomotic stricture.

Conclusions:

• Robotic proximal gastrectomy with DFT is a feasible and effective anti-reflux reconstruction method.
• This technique represents a valuable addition to the surgical armamentarium for gastric cancer in Western centers.
• Successful implementation requires specialized training and adaptation to the Western surgical environment.