| Laparoscopic surgery is no doubt the largest innovation in the history of abdominal surgery. It has unlimited potential for future development including robotic technologies. However, the transition from conventional open surgery to laparoscopic/robotic surgery should be carefully planned so as not to impair surgical perfection established in the long history of open surgery. The following issues should be addressed: At exploration of the abdominal cavity, can we obtain essential information of disease extent without palpation or biopsies of, e.g. suspicious para-aortic nodes? Can we gently handle the stomach without pinching or sticking the tumor? Can we determine the optimal resection line? Can we fully remove the lymph nodes along the upper border of the pancreas within the restricted movements of the devices? Furthermore, there remains a serious concern that laparoscopic/robotic procedure may become a goal rather than a means; some surgeons do select a gastrectomy method not because it is oncologically the best but it is suitable for laparoscopic procedure. To resolve these concerns, efficient training and continuous audit/monitoring systems using NCD should be established. Robotic surgery will soon supersede laparoscopy due to its advantages of short learning curve and far freer device movements, overcoming the cost issue. We should not jump to the goal but carefully bring up these new technologies to the new heights where open gastrectomy cannot reach. |
