Tele-robotic distal gastrectomy with lymph node dissection on a cadaver

Abstract Purpose Robotic telesurgery is growing in popularity; however, it has not yet been validated for gastrointestinal cancer surgery. The purpose of this study is to evaluate the performance of tele-robotic distal gastrectomy (tele-RDG) with lymph node dissection (LND) using a novel Japanese-made surgical robot hinotori™ (Medicaroid, Kobe, Japan) in a cadaver with a presumptive gastric cancer. Methods The Cadaveric Anatomy and Surgical Training laboratory (CAST-Lab.) at Hokkaido University and Kushiro City General Hospital (KCGH) are connected by a guaranteed type line (1 Gbps), and the distance between the two facilities is 250 km. The communication system was conducted over a commercial general line and used hinotori™. A patient cart was installed at CAST-Lab, and a surgeon cockpit was installed at KCGH. Tele-RDG with D2 LND was performed on an adult human cadavers. The evaluation methods included round-trip time (RTT), operation time, Robot Usability Score (RUS), system usability scale (SUS), Global Evaluative Assessment of Robotic Skills (GEARS), and System and Piper Fatigue Scale-12 (PFS-12). Results In all surgical processes, the communication environment was stable without image degradation, and the mean RTT was 40 ms (36.5–55 ms). For tele-RDG with D2 LND, the operation time was 199 min. without any organ injury or technical problems, and the technical evaluation scores (GEARS:28, GOALS:23), usability scores (RUS:34, SUS:82.5), and surgeon fatigue scores (PFS-12:26) were acceptable. Conclusion Tele-RDG with LND using hinotori ™ was feasible and similar to local robotic RDG.