A feasibility of image-guided minimally invasive robotic surgery using preoperative CT scan for gastric cancer patients

Abstract

Purpose: This study was done to assess the feasibility of image-guided surgery in patients with gastric cancer using robotic surgery. We tried to make standardized protocol for vascular reconstruction technique to show images for gastrectomy during robotic gastrectomy in this study.Method: CT angiography was performed preoperatively in 12 patients who underwent robotic gastrectomy in gastric cancer patients. Vessels encountered during gastrectomy are reconstructed during the operation using Aquarius program and transferred to the surgeon console using TilePro program. Seven vascular structures encountered during were evaluated their anatomic variation and distances at each reference point with their 3D-reconstructed digital figure files made by radiologist. These findings were compared with operative findings of each vascular structure by surgeon during surgery.Result: Intraoperatively provided vascular images depicted arterial and venous anatomy around the stomach and were able to identify important vascular variants. During the operation, the information concerning perigastric arteries and veins led us to the site of their branching and facilitated dissection of perigastric lymph nodes and enabled us to avoid accidental hemorrhage and ischemic liver damage. Presented 3D-recontructed CT images to the surgeon’s console during the operation provide each patient’s diverse information such as a vascular map which is critical for surgical guidance, and help to prevent the risks involved in minimal invasive surgery.Conclusion: The image-guided minimally invasive robotic surgery using preoperative CT scan for gastric cancer patients is feasible and useful. Although more remedied and developed system is needed, Image-guided robotic surgery could support to surmount limitations of minimally invasive surgical approach and to apply image guided technology for deformable body structures.