Chinese expert consensus on intracorporeal digestive reconstruction after robotic gastrectomy (2021 edition) / 中华胃肠外科杂志

ABSTRACT

The robotic surgical system applied to gastrectomy is regarded as a safe technique which has similar short- and long-term outcomes compared to laparoscopic and open gastrectomy. With the iteration of anastomotic staplers and improvement of anastomotic skills, coupled with the flexible robot's rotatable device making the manual intracorporal anastomosis easier, gastrointestinal reconstruction after robotic gastrectomy has also started to move toward the era of complete intracorporal anastomosis. In order to further standardize the indications and operating points, the Upper Gastrointestinal Surgery Group of Surgical Branch of Chinese Medical Doctor Association, the Gastrointestinal Surgery Group of Surgery Branch of Chinese Medical Association, the Digestive Tract Cancer Committee of Chinese Research Hospital Association, and Cancer Gastroenterology Society of Chinese Anticancer Association jointly organized domestic experts in general surgery field to formulate the Chinese expert consensus on intracorporal digestive reconstruction after robotic gastrectomy (2021 edition). The definition of intracorporeal digestive reconstruction after robotic gastrectomy is that all surgical steps of digestive reconstruction are done totally in the abdominal cavity by robotic system or all steps mentioned above except jejunojejunal extracorporeal anastomosis. The digestive reconstructions mainly include Billroth I anastomosis, Billroth II anastomosis, Billroth II+ Braun anastomosis, Roux-en-Y anastomosis, Uncut Roux-en-Y anastomosis after distal gastrectomy; double-tract anastomosis, esophagogastric anastomosis by stapler or hand-sewn technique (double flap gastroesophagostomy) after proximal gastrectomy; FEEA method, π-type anastomosis, overlap method and modified procedures, Uncut Roux-en-Y anastomosis, Parisi's double-loop reconstruction after total gastrectomy. Compared with extracorporeal digestive reconstruction, intracorporeal digestive reconstruction operated by robotic system can minimize the surgical incision, reduce the risk of abdominal exposure and accelerate postoperative recovery, etc. Previous studies have demonstrated promising results. We believe that the publication of the consensus will guide surgeons to break through the technical barriers of intracorporeal digestive reconstruction after robotic gastrectomy, which will be more and more widespread with the gradual maturity of domestic robotic systems by bringing less medical costs.