Reconstruction using linear side to side stapled anastomosis following robotic total gastrectomy

Background Worldwide, gastric cancer is the third most common cause of mortality and is the fourth most commonly diagnosed cancer. Minimally invasive surgery using the robotic platform to perform gastrectomy, is gaining popularity worldwide. It allows for better vision, dexterity, better ergonomics for the surgeon, reduced blood loss and lesser pain. Various anastomotic techniques have been suggested including circular stapler, hand sewn, Pi shaped linear stapler anastomosis. We demonstrate our technique performing a robotic side to side linear stapled anastomosis following total gastrectomy. Methods We detail the steps involved in the procedure, including trocar placement, necessary robotic instruments, and surgical description. 56 year old male patient with a BMI of 40 and PS 1, underwent robotic total gastrectomy after neoadjuvant chemotherapy for mid body diffuse adenocarcinoma. Preoperatively staging investigations included endoscopy, staging laparoscopy, computerised tomography (CT) and positron emission tomography (PET). Fitness was assessed using cardio-pulmonary exercise testing (CPET). Results Patient spend one night in high dependency unit, and was stepped down to ward based care. Enhanced recovery after surgery (ERAS) protocol was followed. There were no complications and patient was discharged after 10 days. Conclusions We demonstrate a safe technique for performing side to side linear anastomosis following robotic total gastrectomy.