Laparoscopic approach to proximal gastric cancer using wristed ArtiSential™ instruments: a comparative study of 145 laparoscopic gastrectomies

BACKGROUND: We compared the short- and long-term results of ArtiSential™-operated patients with a historic group of laparoscopic-operated patients. METHODS: A total of 145 patients were included (37 patients in the ArtiSential group and 108 patients in the Laparoscopic group). RESULTS: There were significantly more conversions in the Laparoscopic group compared to ArtiSential™ group (15.7% vs. 2.7%; p = 0.043). The procedure duration was significantly shorter in the ArtiSential™ group (240 ± 49 min vs. 277 ± 58 min; p = 0.001). There were no significant differences in postoperative morbidity and mortality between groups (19.4% in the Lap group vs. 10.8% in the ArtiSential™ group). Multivariate analysis identified intraoperative blood loss (Beta 0.335; 95%CI: 21.774-58.616; p < 0.0001), tumor location (Beta - 0.518; 95%CI: -49 - -25.939; p < 0.0001) and the reconstruction with wristed instruments (Beta - 0.312; 95%CI: -52.261- -16.613; p < 0.0001) as significant predictors for duration of the surgery, while wristed instruments (Beta 0.247; 95%CI: 3.296-13.599; p = 0.001) and the UICC stage (Beta 0.375; 95%CI: 3.205-7.517; p < 0.0001) were significant predictors for the number of extracted lymph nodes. Perioperative chemotherapy (OR 3.521; 95%CI: 1.572-7.883; p = 0.002) and the use of wristed instruments (OR 4.018; 95%CI: 1.441-11.205; p = 0.008) were significant predictors for a complete number 10 lymph node station dissection. CONCLUSION: Our findings suggest that ArtiSential™ wristed instruments offer key benefits in the challenging proximal anastomosis, allowing safe operations on patients with proximal tumors without increasing morbidity or mortality risk.