Robotic Distal Gastrectomy with Lymph Node Dissection for Gastric Cancer

Kei KH. Hosoda, MD, PhD, FACS; Hiroaki Mieno, MD; Akira Ema, MD; Hiromitsu HM. Moriya, MD; Marie Washio, MD; Masahiko Watanabe, MD, PhD, FACS, FASCRS; Keishi Yamashita

Product Details
Product ID: ACS-5660
Year Produced: 2018
Length: 10 min.


Robotic gastrectomy has been gradually accepted as a minimally invasive surgery for gastric cancer. The dexterity of this surgery provides precise dissection of suprapancreatic and infra-pyloric lymph-nodes (LNs), which results in lowering the rate of postoperative complication. We have been performing this surgery since 2015. We will present this technique in detail. We use double bipolar method for almost all the procedures in robotic gastrectomy. After dissecting the #4sb LNs, we start dissection of the #6 LNs. We dissect the adipose tissue surrounding the right gastroepiploic vein to expose the meeting point of the ASPDV and the right gastroepiploic vein. We clip and cut the right gastroepiploic vein just above the meeting point. We dissect the adipose tissue with extreme caution not to injure the pancreatic head and the adipose tissue including the #6 LNs. After dissecting the #6 LNs-including adipose tissue, we clip and cut the right gastroepiploic artery to complete the #6 LN dissection. We cut the duodenum using a da Vinci stapler. Next, we flip up the stomach and start suprapancreatic LN dissection. After clipping and cutting the right gastric artery, we decide the bottom of the #8a LNs and dissect it. We cut the left gastric vein and artery to complete the suprapancreatic LN dissection. Lastly, we dissect the #1 and #3 LNs from the stomach. Then we divide the stomach using da Vinci staplers. After extracting the resected stomach, we perform Roux-en-Y reconstruction. Gastrojejunostomy is performed in functional end-to-end manner using da Vinci staplers.