Skip to main content

Advertisement

SpringerLink
Log in

Da Vinci robot-assisted endoscopic full-thickness gastric resection with regional lymph node dissection using a 3D near-infrared video system: a single-center 5-year clinical outcome

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Endoscopic full-thickness gastric resection (EFTGR) with regional lymph node dissection (LND) has been used for early gastric cancer (EGC) exceeding the indications for endoscopic submucosal dissection (ESD). The extent of the dissected lymph nodes is crucial. A 3D near-infrared (NIR) video robot system significantly enhances visualization of the lymphatic system. However, this system has not been used in EFTGR with LND. Thus, this study assessed the benefits of the 3D NIR video robot system in a clinical setting.

Methods

Between February 2015 and September 2018, 24 patients with EGC exceeding the indications for ESD were treated with EFTGR and LND using a 3D NIR video system with the da Vinci surgical robot. Indocyanine green (ICG) was injected endoscopically around the tumor, and basin node (BN) dissection around the nodes was examined using the 3D NIR video system of the da Vinci Si surgical robot. Subsequently, robot-assisted EFTGR was performed. The primary outcome was the 5-year survival rate.

Result

During a 5-year follow-up of all 24 patients, an 80-year-old patient with an ulcer and T2 invasion was lost to follow-up. Among the remaining 23 patients, no mortality or recurrence was observed.

Conclusion

No metastasis or mortality occurred using the da Vinci robot-assisted EFTGR with LLND and a 3D NIR video system for patients who required radical gastrectomy for EGC in over 5 years. Hence, this may be a safe and effective method for radical gastrectomy; further studies are required confirming its effectiveness.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Kim MY, Cho JH, Cho JY (2014) Ever-changing endoscopic treatment for early gastric cancer: yesterday-today-tomorrow. World J Gastroenterol 20(37):13273–13283

    Article  PubMed  PubMed Central  Google Scholar 

  2. Gotoda T (2007) Endoscopic resection of early gastric cancer. Gastric Cancer 10(1):1–11

    Article  PubMed  Google Scholar 

  3. Japanese Gastric Cancer Association (2023) Japanese gastric cancer treatment guidelines 2021 (6th edition). Gastric Cancer 26:1–25

    Article  Google Scholar 

  4. Jeong U, Bang HY, Kim PS (2021) Clinical significance of additional gastrectomy after non-curative endoscopic submucosal dissection for early gastric cancer: a retrospective single-center study. Korean J Clin Oncol 17(2):68–72

    Article  PubMed  PubMed Central  Google Scholar 

  5. Cho WY, Kim YJ, Cho JY, Bok GH, Jin SY, Lee TH, Kim HG, Kim JO, Lee JS (2011) Hybrid natural orifice transluminal endoscopic surgery: endoscopic full-thickness resection of early gastric cancer and laparoscopic regional lymph node dissection—14 human cases. Endoscopy 43(2):134–139

    Article  CAS  PubMed  Google Scholar 

  6. Lee JH, Ryu KW, Kook MC, Lee JY, Kim CG, Choi IJ, Kim SK, Jang S, Park SR, Kim YW, Nam BH, Bae JM (2008) Feasibility of laparoscopic sentinel basin dissection for limited resection in early gastric cancer. J Surg Oncol 98(5):331–335

    Article  PubMed  Google Scholar 

  7. Alander JT, Kaartinen I, Laakso A, Pätilä T, Spillmann T, Tuchin VV, Venermo M, Välisuo P (2012) A review of indocyanine green fluorescent imaging in surgery. Int J Biomed Imaging 2012:940585

    Article  PubMed  PubMed Central  Google Scholar 

  8. Chen QY, Xie JW, Zhong Q, Wang JB, Lin JX, Lu J, Cao LL, Lin M, Tu RH, Huang ZN, Lin JL, Zheng HL, Li P, Zheng CH, Huang CM (2020) Safety and efficacy of indocyanine green tracer-guided lymph node dissection during laparoscopic radical gastrectomy in patients with gastric cancer: a randomized clinical trial. JAMA Surg 155(4):300–311

    Article  PubMed  Google Scholar 

  9. Kinami S, Oonishi T, Fujita J, Tomita Y, Funaki H, Fujita H, Nakano Y, Ueda N, Kosaka T (2016) Optimal settings and accuracy of indocyanine green fluorescence imaging for sentinel node biopsy in early gastric cancer. Oncol Lett 11(6):4055–4062

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Lee YJ, Jeong SH, Hur H, Han SU, Min JS, An JY, Hyung WJ, Cho GS, Jeong GA, Jeong O, Park YK, Jung MR, Kim YW, Yoon HM, Eom BW, Park JY, Ryu KW; Sentinel Node Oriented Tailored Approach (SENORITA) Study Group (2015) Prospective multicenter feasibility study of laparoscopic sentinel basin dissection for organ preserving surgery in gastric cancer: quality control study for surgical standardization prior to Phase III trial. Medicine (Baltim) 94(45):e1894

    Article  Google Scholar 

  11. Vahrmeijer AL, Hutteman M, van der Vorst JR, van de Velde CJH, Frangioni JV (2013) Image-guided cancer surgery using near-infrared fluorescence. Nat Rev Clin Oncol 10(9):507–518

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Kim H, Lee SK, Kim YM, Lee EH, Lim SJ, Kim SH, Yang J, Lim JS, Hyung WJ (2015) Fluorescent iodized emulsion for pre- and intraoperative sentinel lymph node imaging: validation in a preclinical model. Radiology 275(1):196–204

    Article  PubMed  Google Scholar 

  13. Tajima Y, Yamazaki K, Masuda Y, Kato M, Yasuda D, Aoki T, Kato T, Murakami M, Miwa M, Kusano M (2009) Sentinel node mapping guided by indocyanine green fluorescence imaging in gastric cancer. Ann Surg 249(1):58–62

    Article  PubMed  Google Scholar 

  14. Kwon IG, Son T, Kim HI, Hyung WJ (2019) Fluorescent lymphography-guided lymphadenectomy during robotic radical gastrectomy for gastric cancer. JAMA Surg 154(2):150–158

    Article  PubMed  Google Scholar 

  15. Osterkamp J, Strandby R, Nerup N, Svendsen MB, Svendsen LB, Achiam M (2023) Intraoperative near-infrared lymphography with indocyanine green may aid lymph node dissection during robot-assisted resection of gastroesophageal junction cancer. Surg Endosc 37(3):1985–1993

    Article  PubMed  Google Scholar 

  16. Kitagawa Y, Takeuchi H, Takagi Y, Natsugoe S, Terashima M, Murakami N, Fujimura T, Tsujimoto H, Hayashi H, Yoshimizu N, Takagane A, Mohri Y, Nabeshima K, Uenosono Y, Kinami S, Sakamoto J, Morita S, Aikou T, Miwa K, Kitajima M (2013) Sentinel node mapping for gastric cancer: a prospective multicenter trial in Japan. J Clin Oncol 31(29):3704–3710

    Article  PubMed  Google Scholar 

  17. Baral S, Arawker MH, Sun Q, Jiang M, Wang L, Wang Y, Ali M, Wang D (2022) Robotic versus laparoscopic gastrectomy for gastric cancer: a mega meta-analysis. Front Surg 9:895976

    Article  PubMed  PubMed Central  Google Scholar 

  18. Song WC, Qiao XL, Gao XZ (2015) A comparison of endoscopic submucosal dissection (ESD) and radical surgery for early gastric cancer: a retrospective study. World J Surg Oncol 13:309

    Article  PubMed  PubMed Central  Google Scholar 

  19. Bok GH, Kim YJ, Jin SY, Chun CG, Lee TH, Kim HG, Jeon SR, Cho JY (2012) Endoscopic submucosal dissection with sentinel node navigation surgery for early gastric cancer. Endoscopy 44(10):953–956

    Article  CAS  PubMed  Google Scholar 

  20. Ko WJ, Kim YM, Yoo IK, Cho JY (2018) Clinical outcomes of minimally invasive treatment for early gastric cancer in patients beyond the indications of endoscopic submucosal dissection. Surg Endosc 32(9):3798–3805

    Article  PubMed  Google Scholar 

  21. Goto O, Takeuchi H, Kitagawa Y, Yahagi N (2016) Hybrid surgery for early gastric cancer. Transl Gastroenterol Hepatol 1:26

    Article  PubMed  PubMed Central  Google Scholar 

  22. Eom BW, Yoon HM, Min JS, Cho I, Park JH, Jung MR, Hur H, Kim YW, Park YK, Nam BH, Ryu KW; Sentinel Node Oriented Tailored Approach (SENORITA) Study Group (2019) Prospective multicenter feasibility study of laparoscopic sentinel basin dissection after endoscopic submucosal dissection for early gastric cancer: SENORITA 2 trial protocol. J Gastric Cancer 19(2):157–164

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lee SE, Lee JH, Ryu KW, Cho SJ, Lee JY, Kim CG, Choi IJ, Kook MC, Nam BH, Park SR, Lee JS, Kim YW (2009) Sentinel node mapping and skip metastases in patients with early gastric cancer. Ann Surg Oncol 16(3):603–608

    Article  PubMed  Google Scholar 

  24. Miyashiro I, Hiratsuka M, Sasako M, Sano T, Mizusawa J, Nakamura K, Nashimoto A, Tsuburaya A, Fukushima N, Gastric Cancer Surgical Study Group (GCSSG) in the Japan Clinical Oncology Group (JCOG) (2014) High false-negative proportion of intraoperative histological examination as a serious problem for clinical application of sentinel node biopsy for early gastric cancer: final results of the Japan Clinical Oncology Group multicenter trial JCOG0302. Gastric Cancer 17(2):316–323

    Article  PubMed  Google Scholar 

  25. Son T, Hyung WJ, Lee JH, Kim YM, Kim HI, An JY, Cheong JH, Noh SH (2012) Clinical implication of an insufficient number of examined lymph nodes after curative resection for gastric cancer. Cancer 118(19):4687–4693

    Article  PubMed  Google Scholar 

  26. Okholm C, Svendsen LB, Achiam MP (2014) Status and prognosis of lymph node metastasis in patients with cardia cancer—a systematic review. Surg Oncol 23(3):140–146

    Article  PubMed  Google Scholar 

  27. Ikehara H, Gotoda T, Ono H, Oda I, Saito D (2007) Gastric perforation during endoscopic resection for gastric carcinoma and the risk of peritoneal dissemination. Br J Surg 94(8):992–995

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, CHA Gangnam Medical Center, College of Medicine, CHA University, 566, Nonhyeon-ro, Gangnam-gu, Seoul, Republic of Korea

    Ah Young Lee, Sungwoo Cho, Seong Hwan Kim & Joo Young Cho

  2. Department of Surgery, College of Medicine, Dong-A University, Busan, Korea

    Min Chan Kim

  3. Digestive Disease Center, CHA Bundang Medical Center, College of Medicine, CHA University, Bundang, Korea

    In Kyung Yoo

  4. Department of Surgery, Severance Hospital, Seoul, Korea

    Yoo Min Kim

  5. Institute for Digestive Research, Soonchunhyang University Seoul Hospital, Seoul, Korea

    Tae Hee Lee

  6. Division of Gastroenterology, Department of Internal Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Korea

    Jun-Young Seo

Authors
  1. Ah Young Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Min Chan Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sungwoo Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. In Kyung Yoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yoo Min Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tae Hee Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jun-Young Seo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Seong Hwan Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Joo Young Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joo Young Cho.

Ethics declarations

Disclosures

Ah Young Lee, Min Chan Kim, Sungwoo Cho, In Kyung Yoo, Yoo Min Kim, Tae Hee Lee, Jun-Young Seo, Seong Hwan Kim, Joo Young Cho, have no conflict of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

Five-year postoperative clinical outcomes

 

Da Vinci robot-assisted EFTGR with LLND (n = 24)

Conventional EFTGR with LLND (n = 28)

Local recurrence, n (%)

0 (0)

1 (3.6)

Distant metastasis, n (%)

0 (0)

0 (0)

Death, n (%)

0 (0)

1 (3.6)

Follow-up loss, n (%)

1 (4.2)

2 (7.2)

  1. EFTGR endoscopy-guided full-thickness gastric resection, LLND laparoscopic lymph node dissection

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, A.Y., Kim, M.C., Cho, S. et al. Da Vinci robot-assisted endoscopic full-thickness gastric resection with regional lymph node dissection using a 3D near-infrared video system: a single-center 5-year clinical outcome. Surg Endosc 38, 2124–2133 (2024). https://doi.org/10.1007/s00464-024-10722-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-024-10722-0

Keywords

Search

Navigation