CURRENT STATUS AND FUTURE PERSPECTIVES OF ROBOTIC SURGERY

The Da Vinci Surgical System was developed to overcome some of the disadvantages of conventional endoscopic surgery. We have been performing robotic gastrectomy or esophagectomy in patients with resectable gastric or esophageal cancer who agreed to uninsured use of the robot since 2009, resulting in reduced postoperative local complications including pancreatic fistula following gastrectomy and recurrent laryngeal nerve palsy after esophagectomy. Moreover, the greater the extent of resection and lymph node dissection, the greater this effect, suggesting that the robot may be more beneficial for advanced cancer than for early cancer. In the meantime, there have been a considerable number of reports, mostly focusing on early cancer, that the use of the robot may reduce cost-effectiveness in comparison with the conventional laparoscopic or thoracoscopic approach. Thus, since the beginning of October 2014, we have been conducting a multiinstitutional, single-arm prospective study designed to determine the impact of robotic assistance, which has been approved as advanced medical technology (senshiniryo) by the Japanese Ministry of Health, Labor and Welfare, on the outcomes after minimally invasive radical gastrectomy to treat resectable gastric cancer, with a focus on postoperative complications, long-term outcomes, and cost.