Cirurgia robótica assistida no câncer gástrico: uma revisão de escopo?

Abstract

INTRODUCTION: The evolution of the study of gastric cancer has advanced significantly from the first descriptions to modern studies of pathophysiology and innovative treatment methods. Currently, gastric cancer is one of the leading causes of cancer death, and minimally invasive surgical techniques, including robotic surgery, are increasingly being considered as a therapeutic approach. Robotic surgery, mainly represented by the Da Vinci platform, has shown some advantages over the laparoscopic approach, such as better visualization, greater precision, and a wider range of motion. However, comparative studies conducted so far have shown similar results between the two approaches. This study explores new surgical techniques associated with robotic gastrectomy in gastric cancer, which may potentially add benefits to this approach. OBJECTIVES: To present new surgical techniques in the treatment of gastric cancer associated with the robotic approach. METHOD: This is a Scoping Review study, following the methodological steps proposed by the Joanna Briggs Institute, using the following guiding question: “What is new associated with robot-assisted gastrectomy in gastric cancer in the last 10 years?” The search was conducted in the Medical Literature and Retrieval System Online (MEDLINE) databases, via PubMed, SCOPUS (Elsevier), EMBASE (Elsevier), and Cochrane Library, using the keywords: ('robotic' OR 'robot-assisted surgery' OR 'robot-enhanced surgery' OR 'robotic surgical procedure') AND ('gastrectomy'/exp OR gastrectomy) AND ('gastric cancer'/exp OR 'gastric cancer'). RESULTS: Thirty-one articles containing innovative techniques were selected, the main ones being: use of Indocyanine Green, Carbon Nanoparticles, Single Port Access, Lap Protector, Vessel Sealer Extended, Soft Coagulation Scissors Technique, Artificial Intelligence, 3D Navigation, Advanced Real‐time Multi‐display Educational System (ARMES), Double Loop Reconstruction Method and Delta Anastomosis DISCUSSION: The techniques highlighted in this work demonstrate that the field of robotic surgery is constantly evolving in search of improvements and advantages to the method. Among them, those that use Artificial Intelligence (AI) and the 3D Virtual Navigation System stand out, enabling the identification of anatomical structures, as well as intraoperative phases, thus preventing intraoperative risks, providing greater safety to the procedure, and an image-guided intraoperative planning. Additionally, the use of Indocyanine Green and Carbon Nanoparticles (CNSI) for lymph node visualization facilitates the performance of effective lymphadenectomy. CONCLUSION: Nine techniques associated with robotic gastrectomy were identified: 2 computational techniques, 2 techniques using devices/instruments, 2 techniques for marking anatomical structures, 1 educational technique, and 2 anastomosis techniques in the digestive system.