Short-term outcomes and cost-effectiveness of laparoscopic gastrectomy with articulating instruments for gastric cancer compared with the robotic approach

Abstract

To overcome the limitations of laparoscopic surgery, robotic systems have been commonly used in the era of minimally invasive surgery despite their high cost. However, the articulation of instruments can be achieved without a robotic system at lower cost using articulating laparoscopic instruments (ALIs). Between May 2021 and May 2022, perioperative outcomes following laparoscopic gastrectomy using ALIs versus robotic gastrectomy were compared. A total of 88 patients underwent laparoscopic gastrectomy using ALIs, while 96 underwent robotic gastrectomy. Baseline characteristics were similar between the groups except for a higher proportion of patients with a medical history in the ALI group (p = 0.013). Clinicopathologic and perioperative outcomes were not significantly different between the groups. However, the operation time was significantly shorter in the ALI group (p = 0.026). No deaths occurred in either group. In conclusion, laparoscopic gastrectomy using ALIs was associated with comparable perioperative surgical outcomes and a shorter operation time compared to robotic gastrectomy in this prospective cohort study.

Figure 1

Patient flow diagram. Of the 250 patients who underwent gastrectomy for gastric cancer during the 1-year study period, 66 patients met the exclusion criteria and were therefore excluded from the study. The remaining 184 patients included 88 patients who underwent laparoscopic surgery using ALIs and 96 who underwent robotic surgery. ALI, articulating laparoscopic instrument.

Figure 2

Articulating function for supra-pancreatic lymph node dissection. (a) Overview of the fenestrated forceps and medium-large clip applier. (b) Snapshot of the 12a area lymph node dissection using ALI. (c) Lifting lymph nodes without disturbing the movement of the energy device is necessary. Dissection of the 11p area also requires upward traction of the lymph nodes creating space for the approaching energy devices. The same applies to robots adequately exposing the deep-seated 12a (d) and 11p (e) tissues. CHA, common hepatic artery; PV, portal vein; SA, splenic artery; SV, splenic vein; LN, lymph node.