IMPORTANCE The current research aimed to conduct a detailed analysis of intraoperative surgical performance, short-term outcomes, identify and categorize technical errors, and hazard-zones enacted during total gastrectomy performed robotically and laparoscopically by surgeons. Prospective research is needed to determine whether the technical advantages of robotic surgery translate to patient outcomes. OBJECTIVE Identify and process risk areas in robot-assisted total gastrectomy (RTG) and laparoscopic total gastrectomy (LTG) to get the best patient results. DESIGN Patients undergoing RTG and LTG were recruited and randomized into the study. Six consultant/attending surgeons participated in this study and all surgical procedures were recorded. The unedited surgical video-recordings were handed over to third-party experts for granular analysis of the procedures using objective clinical human reliability analysis (OC-HRA) for the quality of intraoperative performance, technical errors, intraoperative complications. SETTING This study is a single center prospective randomized controlled trial. PARTICIPANTS 82 patients were recruited and participated in this study with 40 cases undergoing RTG and 42 cases for LTG. INTERVENTIONS RTG vs LTG. MAIN OUTCOMES AND MEASURES Determine whether RTG or LTG can provide the better intraoperative technical performance and identify the most hazardous zone (area) during total gastrectomy (TG). RESULTS The technical errors enacted and identified in the RTG and the LTG were (46.11±5.63 VS 58.79±8.45, P＜0.001) respectively. The highest number of technical errors was identified during the dissection of the supra-pancreatic lymph nodes (Task Zones3, TZ3), including No.5, 7, 8a, 9, 11p, and 12a to complete the nodal clearance around the celiac artery and its trifurcation (7.29±1.88 VS 9.43±2.24, P <0.001) in both RTG and LTG. The number of lymph nodes harvested with RTG was higher than LTG (35.36±7.51 VS 30.54±6.95, P=0.016), especially in the upper margin of the pancreas (13.32±4.17 VS 9.36±3.81, P＜0.001). The total cost of hospitalization in the RTG group cost 3% more than LTG group ($15953.41±3533.91 VS $12198.26±2761.27, P＜0.001). CONCLUSIONS This study offers compelling OC-HRA evidence demonstrating that RTG facilitates significantly superior technical performance compared to LTG. Whether examining short-term clinical outcomes or intraoperative operations, the robotic surgery system consistently outperforms laparoscopic surgery. Lymph node dissection in the supra-pancreatic region emerged as a major hazard zone in both procedures. TRIAL REGISTRATION chictr.org.cn: ChiCTR2000039193.

中文翻译：

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机器人与腹腔镜全胃切除术治疗胃癌的技术错误和风险区的识别和分类：一项单中心前瞻性随机对照研究。


重要性 目前的研究旨在对外科医生在机器人和腹腔镜进行全胃切除术过程中的术中手术性能、短期结果、识别和分类技术错误和危险区进行详细分析。需要前瞻性研究来确定机器人手术的技术优势是否转化为患者的预后。目的 识别和处理机器人辅助全胃切除术 （RTG） 和腹腔镜全胃切除术 （LTG） 中的风险区域，以获得最佳患者结果。设计 招募接受 RTG 和 LTG 的患者并随机分配到研究中。6 名顾问/主治外科医生参与了这项研究，并记录了所有外科手术。未经编辑的手术录像移交给第三方专家，使用客观临床人体可靠性分析 （OC-HRA） 对手术进行精细分析，以了解术中性能、技术错误、术中并发症的质量。地点 本研究是一项单中心前瞻性随机对照试验。参与者 招募并参与了本研究 82 例患者，其中 40 例接受 RTG，42 例接受 LTG。干预措施 RTG 与 LTG。主要结局和措施 确定 RTG 或 LTG 是否可以提供更好的术中技术性能并确定全胃切除术 （TG） 中最危险的区域（区域）。结果 RTG 和 LTG 中制定和识别的技术错误分别为 （46.11±5.63 vs 58.79±8.45，P<0.001）。在解剖胰上淋巴结（任务区 3，TZ3）时发现的技术错误数量最多，包括 No.5、7、8a、9、11p 和 12a 在 RTG 和 LTG 中完成腹腔动脉及其三分叉周围的淋巴结清除 （7.29±1.88 vs 9.43±2.24，P <0.001）。RTG 采集的淋巴结数量高于 LTG （35.36±7.51 VS 30.54±6.95，P = 0.016），尤其是胰腺上缘 （13.32±4.17 VS 9.36±3.81，P<0.001）。RTG 组的总住院费用比 LTG 组高 3%（15953.41±3533.91 美元 VS 12198.26±2761.27 美元，P<0.001）。结论 本研究提供了令人信服的 OC-HRA 证据，表明与 LTG 相比，RTG 有助于显着优越的技术性能。无论是检查短期临床结果还是术中手术，机器人手术系统的性能始终优于腹腔镜手术。胰腺上区淋巴结清扫术在这两种手术中都成为主要危险区。试验注册 chictr.org.cn：ChiCTR2000039193。