102: Robotic-assisted minimally invasive radical total gastrectomy with intracorporeal side-to-side esophagojejunostomy

Minimally invasive total gastrectomy is an option that has proved to be equivalent in oncologic outcomes when compared to open surgery. Additionally, minimally invasive surgery provides benefits such as smaller incisions, less postoperative pain, shorter in-hospital stay and precise dissection. However, minimally invasive approaches have strict limitations due to the difficulties of a total robotic gastrectomy.


Methods:

We performed a minimally invasive robotic-assisted total gastrectomy and we have performed complete intracorporeal anastomosis including side to side esophago-jejunostomy and side to side jejuno-jejunostomy which provided precise dissection and adequate oncologic outcomes.


Results:

This video demonstrates the robotic-assisted total gastrectomy in a 40-year-old woman with diffuse type adenocarcinoma (stage T1A). Radical omentectomy was performed. Right gastroepiploic artery, supra and infrapyloric lymph nodes are dissected and the duodenum is transected. The common and proper hepatic artery and the left gastric artery, vein and lymph nodes are dissected. Right crura is identified. Umbilical tape aids in the dissection of the hiatus and the esophagus which is transected. The specimen is tuched to the right subdiaphragmatic space for later extraction. Ligament of Treitz is identified and 25 cm distal, an opening in the mesentery is created. Jejunum is transected, and mesentery is prepared for Roux in Y reconstruction. The jejuno-alimentary limb is brought up to the hiatus and a stay stich is placed between the Roux limb and esophagus. And esophagotomy is created. The jejuno limb is prepared and enterotomy is performed to match the esophageal opening. A side side staple esophago-jejunostomy is created. The common enterotomy is closed with handsewn two-layer fashion. The jejuno-jejustomy is created and a stay stich is placed between the pancreatico-biliary limb and the alimentary limb. The common enterotomies are created using the harmonic device. A linear stapler with 60 mm cartridges is used to create the side-to-side anastomosis. The common enterotomy is closed with the use of self-retaining 3-0 stich. The mesenteric defects are closed, radiologic images evidenced patent anastomosis and the patients was discharged in postoperative day 3.


Conclusions:

Minimally invasive robotic-assisted gastrectomy is a feasible approach that can provide excellent oncologic outcomes in gastric cancer treatment. Also, the use of the robotic platform allows to maneuver these anastomoses in an easier way.