Background: This study was performed to validate the feasibility and role of image-guided robotic surgery using preoperative computed tomography (CT) images for the treatment of gastric cancer. Methods: Twelve patients scheduled to undergo robotic gastrectomy for gastric cancer were registered. Vessels encountered during gastrectomy were reconstructed using 3D software and their anatomical variation was evaluated using preoperatively performed CT-angiography. The vascular information was transferred to a robot console using a multi-input display mode. Radiologic findings acquired from preoperative CT by the radiologist were compared with intraoperative findings of the surgeon. This study is registered with www.clinicaltrials.gov as NCT01338948. Results: All 12 robotic gastrectomies were performed without any problems. All anatomical data acquired using 3D software were transferred successfully during surgery. Intraoperative vascular images depicted vasculatures around the stomach and could identify important vascular variations. During surgery, relevant vascular information led the surgeon to branch sites and facilitated lymphadenectomy around the vessels. Image-guidance during the operation provided a vascular map and enabled the surgeon to avoid accidental bleeding and damage to other organs by preventing vascular injuries. Conclusion: Image-guided robotic surgery for gastric cancer using preoperative CT-angiography reconstructed during operation by a surgically trained radiologist who could adjust the images by anticipating the operative procedure was feasible and improved the efficiency of surgery by eliminating the possibility of vascular injuries.
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Acknowledgments The authors thank Dong-Su Jang Research Assistant, Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea for his work on the illustrations of this article. The authors thank Katherine M Stefani English Editor, Yonsei University College of Medicine, Seoul, Korea for her work on the English proofreading of this article. This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health and Welfare, Republic of Korea (1020410).
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