Advancement of Minimally invasive surgery
Laparoscopic surgery, has been dramatically increasing during the past several decades and has several benefits as minimally invasive surgery over conventional open surgery in the field of gastrointestinal surgery. Furthermore, in recent years, with the development of surgical-assist robots, robotic surgery has come to play a central role in gastrointestinal surgery. In 2018, robotic surgery for gastric and colorectal cancer was covered by the insurance. We introduced robotic surgery for gastrointestinal cancer (Photo 1).
Robotic surgery is the next generation of medical platform that can provides several advantages, including a three-dimensional magnified surgical field of view, an ergonomic surgical environment, natural hand–eye coordination, stable instrument movement, minimal surgeon fatigue, and minimal tremor filtering.
Our department is currently staffed by 8 surgeons certified by the Endoscopic Surgical Skill Qualification System (ESSQS) of the Japan Society for Endoscopic Surgery, including four Robo-Doc Pilot of the Japan Robotic Surgery Society.
Robotic surgery for gastric cancer and colorectal cancer
Since insurance coverage in 2018, we have performed approximately 170 robotic gastrectomy for gastric cancer to date (January 2024). Initially introduced for early-stage cancer, robotic surgery has been indicated for advanced gastric cancer, function-preserving surgery aimed at preserving gastric function, surgery after neoadjuvant chemotherapy, conversion surgery, residual gastric cancer, and esophagogastric junction cancer.
We have reported the usefulness of robotic surgery in comparison with conventional laparoscopic surgery and established the Left-handed laparoscopic coagulation shears (LCS) technique, which uses LCS on the left hand side of the robot (Photo 2). Recently, the number of upper gastric cancer has been increasing due to eradication of H. pylori. It is considered difficulty in the dissection the gastrosplenic ligament and the reconstruction after proximal gastrectomy or total gastrectomy. We established a novel technique called the pincer approach to the gastrosplenic ligament in robotic total/proximal gastrectomy for upper gastric cancer. For reconstruction, we use the esophagogastrostomy technique to prevent postoperative stenosis and reflux.
Until now, we have been performing surgeries using the surgical support robot da Vinci, and in September 2023, we started robotic gastrectomy using hinotori (Photos 3 and 4). It will increase the number of options and lead to safer and more advanced medical care for patients.
As for colorectal cancer, robotic surgery has been performed in a total of 220 cases of colon and rectal cancer to date. For lower rectal cancer, which is considered particularly difficult to treat, we perform a hybrid robotic surgery which is the combination of transanal mesorectal excision (TaTME) and robotic surgery. We also introduced robotic extended surgery for locally advanced lower rectal cancer that has spread to the prostate and vagina and have performed total pelvic exenteration and combined resection of the prostate and vagina with excellent surgical outcomes.
Robotic surgery for hepatobiliary and pancreatic (HBP) cancer
We also perform an average of approximately 60 to 80 pancreatectomies per year and 20 to 40 pancreatectomies per year. And in recent years. laparoscopic hepatectomy and pancreatectomy have become as standard treatment. Since 2023, we have introduced robotic hepatectomy and pancreatectomy for liver and pancreatic tumors. The introduction of robotic surgery is expected to enable safer and less physically demanding operations, and we plan to expand the indications for more challenging cases in the future.