渡邊 祐介

BACKGROUND: Single-port surgery offers improved cosmesis but is technically demanding. The da Vinci™ SP (DVSP) system aims to overcome these challenges; however, rigorous data on the comparison between the DVSP system and the standard multi-port da Vinci™ Xi system (DVXi) are scarce. This study aimed to compare the short-term outcomes of the DVSP with those of the DVXi for robotic distal gastrectomy after adjusting for patient selection bias. METHODS: We retrospectively reviewed 311 patients undergoing robotic distal gastrectomy for gastric cancer between March 2023 and December 2024 at two institutions. Based on patient demographics and tumor characteristics, a 1:1 propensity score matching analysis was performed to mitigate bias. After matching, 36 patients in the DVSP group were compared with 36 patients in the DVXi group. Perioperative outcomes, pathological findings, and postoperative complications were analyzed. RESULTS: The DVSP group had significantly shorter median operative time (329 vs. 414 min, p < 0.001) and console time (261 vs. 332 min, p < 0.001). A significantly higher number of lymph nodes were retrieved in the DVSP group (mean 46 vs. 32, p = 0.04). The median postoperative stay exhibited a trend toward being shorter in the DVSP group (11 vs. 12 days, p = 0.08). No conversions to open or multi-port surgery occurred. The incidence of postoperative complications (Clavien-Dindo grade ≥ II) was comparable between the groups (8.3% vs. 16.7%, p = 0.48). CONCLUSIONS: In this study, single-port gastrectomy using the DVSP system was safe and feasible in the short-term outcomes compared with multi-port gastrectomy using the DVXi system.

BACKGROUND: Intracorporeal delta-shaped Billroth I (B-I) anastomosis following minimally invasive distal gastrectomy (DG) is a simple and highly reproducible gastroduodenostomy procedure. This study aimed to identify the technical pitfalls of this procedure and assess their influence on one-year outcomes. METHODS: This was a retrospective study including patients who underwent delta-shaped B-I anastomosis following minimally invasive DG at our institution between 2008 and 2022. Delta-shaped B-I anastomosis was performed by adhering to five fundamental elements. Data were collected from our prospectively maintained database and analyzed retrospectively. Intra- and postoperative complications were reviewed, and video analysis was performed to identify technical errors associated with these complications. One-year outcomes, including nutritional status and endoscopic findings, were compared between patients with and without complications within 30 days after surgery. RESULTS: A total of 749 patients were included in this study. A total of 36 operating surgeons were involved. Intraoperative anastomotic complications occurred in 0.8% of patients, mainly due to technical issues during linear stapling. Postoperative anastomosis-related complications occurred in 2.1% of patients, with anastomotic leakage, stricture, and delayed gastric emptying rates of 0.9%, 0.3%, and 0.9%, respectively. Most complications were managed conservatively or endoscopically. No late-onset strictures were observed at postoperative year 1, and no significant differences in nutritional and endoscopic findings were observed between patients with and without complications. CONCLUSION: When performed according to five fundamental technical principles, intracorporeal delta-shaped B-I anastomosis following minimally invasive DG proved to be a safe, reproducible procedure associated with favorable one-year outcomes.

BACKGROUND: Accurate liver volume measurement is crucial for evaluating liver cyst severity and treatment efficacy in polycystic liver disease (PLD). Previous methods are impractical because they are time-consuming and labor-intensive. This study developed and validated two simplified CT imaging methods: the Bi-axial Simplified Measurement Method (BASiM) and the Quadri-dimensional Simplified Measurement Method (QDSiM). METHODS: This retrospective study analyzed 76 CT images from 26 PLD patients who underwent transarterial hepatic artery embolization (TAE). Images were obtained before TAE, 24 weeks after TAE and during the follow-up period. Liver volumes were measured using semi-automatic volumetry, BASiM, and QDSiM. BASiM calculates liver volume based on cranio-caudal, anterior-posterior, and medial-lateral dimensions, while QDSiM divides the liver into left- and right-side sections. This study assessed inter-assessor reliability, measurement accuracy, volume change rate, and calculation times. RESULTS: BASiM demonstrated strong inter-assessor reliability (intraclass correlation coefficient [ICC]: 0.991, 95% confidence interval [CI] 0.986-0.994) superior to QDSiM (ICC: 0.851, 95% CI 0.205-0.949). Calibrated liver volumes using BASiM and QDSiM were consistent with semi-automatic volumetry (ICC: 0.924, 95% CI 0.858 to 0.957, and ICC: 0.934, 95% CI 0.806-0.970, respectively). BASiM showed better alignment with volume changes (ICC: 0.835, 95% CI 0.537-0.927) compared to QDSiM (ICC: 0.607, 95% CI 0.203-0.800) and required less measurement time (61 ± 4 s vs. 107 ± 9 s, p < 0.01). CONCLUSION: BASiM provided superior reliability, accuracy, and efficiency for liver volume measurement in PLD, thus useful for the clinical management of PLD.

PURPOSE: Reduced-port surgery has been utilized in gastric cancer surgery but is not predominantly used due to its high technical difficulty. A new single-port surgical robot named da Vinci™ SP System (DVSP) was launched and eventually approved for clinical use in Japan in November 2022. We initiated robotic gastrectomy for gastric cancer using DVSP in March 2023. Here, we report our initial experiences and assessments of the feasibility and safety of robotic gastrectomy for gastric cancer using DVSP. METHODS: This single-center retrospective study included 20 patients with gastric cancer who underwent robotic gastrectomy with DVSP from March 2023 to April 2024. The primary endpoint was the postoperative complication rate within 30 days postoperatively. Secondary endpoints were surgical outcomes, including intraoperative adverse events, operative time, blood loss, and the number of dissected nodes. RESULTS: Of the 20 patients, 6 (30.0%) were male. The median age was 74 years. Tumors in the middle to lower stomach were observed in 20 patients (100.0%), including 18 (90.0%) and 2 (10.0%) with clinical stages I and II diseases, respectively. All patients underwent distal gastrectomy. The postoperative complications of Clavien-Dindo grade ≥ II occurred in 3 (15%) patients. Intraoperative adverse events, including conversion to other approaches, were not observed. All patients underwent R0 resection. The median operative and console times were 289 and 240 min, respectively. The median blood loss was 11 mL with 50 dissected nodes. CONCLUSION: This study revealed the safe performance of robotic distal gastrectomy with standard lymphadenectomy for clinical stage I/II gastric cancer using DVSP.