Laparoscopic approach to proximal gastric cancer using wristed ArtiSential™ instruments: a comparative study of 145...

We compared the short- and long-term results of ArtiSential™-operated patients with a historic group of laparoscopic-operated patients.

A total of 145 patients were included (37 patients in the ArtiSential group and 108 patients in the Laparoscopic group).

There were significantly more conversions in the Laparoscopic group compared to ArtiSential™ group (15.7% vs. 2.7%; p = 0.043). The procedure duration was significantly shorter in the ArtiSential™ group (240 ± 49 min vs. 277 ± 58 min; p = 0.001). There were no significant differences in postoperative morbidity and mortality between groups (19.4% in the Lap group vs. 10.8% in the ArtiSential™ group). Multivariate analysis identified intraoperative blood loss (Beta 0.335; 95%CI: 21.774-58.616; p < 0.0001), tumor location (Beta - 0.518; 95%CI: -49 - -25.939; p < 0.0001) and the reconstruction with wristed instruments (Beta - 0.312; 95%CI: -52.261- -16.613; p < 0.0001) as significant predictors for duration of the surgery, while wristed instruments (Beta 0.247; 95%CI: 3.296-13.599; p = 0.001) and the UICC stage (Beta 0.375; 95%CI: 3.205-7.517; p < 0.0001) were significant predictors for the number of extracted lymph nodes. Perioperative chemotherapy (OR 3.521; 95%CI: 1.572-7.883; p = 0.002) and the use of wristed instruments (OR 4.018; 95%CI: 1.441-11.205; p = 0.008) were significant predictors for a complete number 10 lymph node station dissection.

Our findings suggest that ArtiSential™ wristed instruments offer key benefits in the challenging proximal anastomosis, allowing safe operations on patients with proximal tumors without increasing morbidity or mortality risk.