Abstract：
BACKGROUND: Robotic distal gastrectomy (RDG) with Billroth I (BI) reconstruction is predominantly performed due to its physiological congruence and simplicity. The Intracorporeal Triangular Anastomotic Technique (INTACT) aims to reduce ischemic areas compared to the conventional Delta-shaped anastomosis using the unique characteristics of robotic surgery to standardize procedures, thereby ensuring safe, simple, and reliable reconstruction. This study aims to investigate the efficacy of the INTACT in RDG with BI reconstruction, focusing on its robotic precision in minimizing ischemic zones and improving surgical reliability.
METHODS: The posterior duodenal wall is dissected before reconstruction, and the hepatoduodenal ligament is severed to facilitate passive duodenal manipulation. A quarter-circumference incision is created centrally on the anterior wall of the duodenal stump to avoid excessive tension during anastomosis and to ensure an adequate anastomotic diameter. A small opening is established on the greater curvature of the remaining stomach, and the posterior walls of the stomach and duodenum are joined using a Linear stapler in the first fire. A V-shape is created, and two EndoWrist instruments (robotic first and fourth arms) are utilized to grip and extend the anastomosis diameter, completing the anastomosis with a shared hole closure using the Linear stapler. The robotic arms\' features improve the physiological integrity and stability of the BI reconstruction.
RESULTS: A total of 81 patients underwent RDG with INTACT from September 2020 to January 2024. The median age was 72 years (range: 31-91), with 49 males and 32 females. The median blood loss was 0 ml (range: 0-200 ml), and the median postoperative hospital stay was 8 days (range: 6-20 days). No cases required reanastomosis during surgery, and no postoperative anastomotic leakage, surgery-related reoperations, or anastomotic strictures were reported.
CONCLUSIONS: INTACT in RDG can be safely performed. The characteristics of the EndoWrist instruments helped in stabilizing the technique, making it a viable option in robotic-assisted surgeries.
METHODS: The posterior duodenal wall is dissected before reconstruction, and the hepatoduodenal ligament is severed to facilitate passive duodenal manipulation. A quarter-circumference incision is created centrally on the anterior wall of the duodenal stump to avoid excessive tension during anastomosis and to ensure an adequate anastomotic diameter. A small opening is established on the greater curvature of the remaining stomach, and the posterior walls of the stomach and duodenum are joined using a Linear stapler in the first fire. A V-shape is created, and two EndoWrist instruments (robotic first and fourth arms) are utilized to grip and extend the anastomosis diameter, completing the anastomosis with a shared hole closure using the Linear stapler. The robotic arms\' features improve the physiological integrity and stability of the BI reconstruction.
RESULTS: A total of 81 patients underwent RDG with INTACT from September 2020 to January 2024. The median age was 72 years (range: 31-91), with 49 males and 32 females. The median blood loss was 0 ml (range: 0-200 ml), and the median postoperative hospital stay was 8 days (range: 6-20 days). No cases required reanastomosis during surgery, and no postoperative anastomotic leakage, surgery-related reoperations, or anastomotic strictures were reported.
CONCLUSIONS: INTACT in RDG can be safely performed. The characteristics of the EndoWrist instruments helped in stabilizing the technique, making it a viable option in robotic-assisted surgeries.
摘要：
背景：具有BillrothI（BI）重建的机器人远端胃切除术（RDG）主要是由于其生理一致性和简单性。与传统的三角形吻合术相比，体内三角形吻合术（INTACT）旨在利用机器人手术的独特特征来标准化手术，以减少缺血面积。从而确保安全，简单,可靠的重建。本研究旨在探讨INTACT在RDG伴BI重建中的疗效，专注于其机器人精度，最大限度地减少缺血区和提高手术可靠性。
方法：重建前解剖十二指肠后壁，切断肝十二指肠韧带以促进被动十二指肠操作。在十二指肠残端的前壁中央形成四分之一圆周切口，以避免吻合期间过度紧张并确保足够的吻合直径。在剩余胃的较大曲率上建立一个小开口，胃和十二指肠的后壁在第一次火灾中使用线性订书机连接。创建一个V形，和两个EndoWrist仪器（机器人第一和第四臂）被用来抓住和延长吻合直径，使用线性吻合器通过共用孔闭合完成吻合。机械臂的特征提高了BI重建的生理完整性和稳定性。
结果：从2020年9月至2024年1月，共有81例患者接受了RDG与INTACT。中位年龄为72岁（范围：31-91），男性49人，女性32人。中位失血量为0ml（范围：0-200ml），中位术后住院时间为8天（范围：6-20天）。手术期间没有病例需要再吻合，术后无吻合口漏,手术相关的再手术,或报告吻合口狭窄。
结论：RDG中的INTACT可以安全地进行。EndoWrist仪器的特性有助于稳定该技术，使其成为机器人辅助手术的可行选择。
方法：重建前解剖十二指肠后壁，切断肝十二指肠韧带以促进被动十二指肠操作。在十二指肠残端的前壁中央形成四分之一圆周切口，以避免吻合期间过度紧张并确保足够的吻合直径。在剩余胃的较大曲率上建立一个小开口，胃和十二指肠的后壁在第一次火灾中使用线性订书机连接。创建一个V形，和两个EndoWrist仪器（机器人第一和第四臂）被用来抓住和延长吻合直径，使用线性吻合器通过共用孔闭合完成吻合。机械臂的特征提高了BI重建的生理完整性和稳定性。
结果：从2020年9月至2024年1月，共有81例患者接受了RDG与INTACT。中位年龄为72岁（范围：31-91），男性49人，女性32人。中位失血量为0ml（范围：0-200ml），中位术后住院时间为8天（范围：6-20天）。手术期间没有病例需要再吻合，术后无吻合口漏,手术相关的再手术,或报告吻合口狭窄。
结论：RDG中的INTACT可以安全地进行。EndoWrist仪器的特性有助于稳定该技术，使其成为机器人辅助手术的可行选择。
