Stapler-Less Robotic Partial Gastrectomy: a Safety and Feasibility Experimental Study
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No true preliminary work has been performed and published on the use of the bipolar cautery devices for transection of the stomach when performed as a part of the sleeve gastrectomy or gastric wedge resection. The objective of this study was to investigate the feasibility and safety of substitution of linear surgical stapling devices for use of a bipolar electrosurgical sealing instrument in the performance of a totally robotic partial gastrectomy (TRPG).
Ten female pigs were assigned to an intervention or control group. Intervention included TRPG with a robotic bipolar tissue coagulation device. In the control group, TRPG was performed using the staplers. Assessed outcomes included presence of the intraoperative and postoperative bleeding or leak and features of the sections from the stapled line or sutured line.
Mean operating time was (130 ± 31 min) and (87 ± 23 min) in the study and control groups (p = 0.03). Intraoperative gastroscopy revealed slow bleeding associated with the staple line in 3/5 control pigs; oozing was not appreciated in any of the study pigs (0/5). No leak was detected during intraoperative gastroscopy. No major complications were suspected postoperatively or identified at postmortem exam in either group. Mean injury width was (1.12 ± 0.93 mm) in the control group with greater mean injury width (7.88 ± 3.73 mm) in the study group (p = 0.001). Mean depth of ulceration was (0.99 ± 0.94 mm) in the control group, with greater mean ulceration depth (2.25 ± 0.84 mm) in the study group (p = 0.002).
The study showed the technical feasibility of performing stapler-less gastric wedge resection. The electrocautery alone failed to demonstrate the technical feasibility which was obtained with the concomitant use of a tissue clamp and a suture.
KeywordsStapler-less totally robotic sleeve gastrectomy Partial gastrectomy Wedge gastric resection Animal model Experimental surgery
Affordable Care Act
Accountable Care Organization
American Society of Metabolic and Bariatric Surgeons
Laboratory animal research
Laparoscopic Roux-en-Y gastric bypass
Laparoscopic sleeve gastrectomy
Roux-en-Y gastric bypass
Totally robotic sleeve gastrectomy
Compliance with Ethical Standards
Ethical Approval Statement
All applicable institutional and/or national guidelines for the care and use of animals were followed. The Cleveland Clinic’s Institutional Animal Care and Use Committee approved the study protocol (2015-1377).
Informed Consent Statement
Does not apply.
The study was supported by Intuitive Surgical, Sunnyvale, CA, USA (2015 Clinical Robotic Research Grant) to help offset the costs associated with acquisition and perioperative care of the animals.
The study was carried out at the Cleveland Clinic Animal Facility which is fully accredited by AAALAC International.
Conflict of Interest
Tomasz Rogula reports grants and non-financial support from Intuitive Surgical, during the conduct of the study.
David Leifer has nothing to disclose.
Jacob A. Petrosky has nothing to disclose.
Xiuli Liu has nothing to disclose.
Michal Janik has nothing to disclose.
Valerie Zeer has nothing to disclose.
Piotr Fiedorczuk has nothing to disclose.
Jan Baczek has nothing to disclose.
Philip Schauer has nothing to disclose.
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