Page 191 - Read Online

Page 2 of 9 Tokunaga et al. J Cancer Metastasis Treat 2018;4:40 I http://dx.doi.org/10.20517/2394-4722.2017.80

A

B

Figure 1. (A) Surgical field during LG: straight devices without articulation are used; (B) surgical field during RG: articulated devices are used

Using the da Vinci® Surgical System (Intuitive Surgical, Sunnyvale, CA, USA), a system for robotic surgery,
surgeons are able to attain a three-dimensional view, instrument flexibility, tremor suppression, and improved
ergonomics, which are thought to be advantages of robotic gastrectomy (RG) [8-11] . With these advantages,
theoretically, RG enables surgeons to perform more precise surgery with less trauma, which could result in
superior outcomes over LG. However, the number of comparative prospective studies between RG and LG is
quite limited, and therefore, solid evidence supporting RG does not yet exist [12-16] .

Herein, we would review the comparative retrospective and prospective studies which have investigated the
differences in short- and long-term surgical outcomes between RG and LG.

Clear advantages of RG over LG
There are several clear benefits of RG which contribute to reducing invasiveness and trauma compared with
LG. Articulated devices, which are only available in RG, make each surgical technique more meticulous
and precise, and are thought to be one definitive advantage of RG [Figure 1] [8-13] . Other apparent advantages
include a tremor suppression function, which is helpful to keep a stable surgical field and effective to reduce
organ injury, and a three-dimensional image, which has become available in LG although special equipment
is necessary. With these clear advantages, RG is expected to have advantages over LG. Clear and possible
advantages and disadvantages of both procedures are summarized in Table 1.

Clear disadvantages of RG
Because RG requires expensive machines and devices, cost effectiveness is an intriguing issue for surgeons,
and seems to be an absolute disadvantage of RG. In Korea and Japan, where more than half of reports have