A randomized trial comparing the safety and efficacy of straight and articulating instruments (ArtiSential) in laparoscopic gastrectomy for gastric cancer patients

Abstract In conventional multiport laparoscopic radical gastrectomy, there is a lack of evidence demonstrating that articulating instruments (ArtiSential) improve surgical quality, particularly for suprapancreatic lymph node dissection and pancreas-related complications. This study evaluated the efficacy and safety of using an articulating instrument. In this single-center prospective study, 76 patients undergoing laparoscopic radical gastrectomy were randomized to a control or experimental (articulating) group. In the articulating group, an articulating instrument was used by the assistant for pancreatic traction during suprapancreatic lymph node dissection. The primary endpoint was suprapancreatic lymph node dissection time; secondary endpoints included operative outcomes, early postoperative complications, and the number of retrieved suprapancreatic lymph nodes. Between July and December 2023, 38 patients were allocated to each group. The suprapancreatic lymph node dissection time was comparable between the two groups (Control: 20.74 ± 8.2 min; Articulating: 20.42 ± 7.5 min; P = 0.861). Additionally, there were no significant differences in total operation time, pancreatic enzyme levels (in both the serum and peritoneal fluid), and the number of retrieved suprapancreatic lymph nodes (Control: 15.66 ± 4.7; Articulating: 15.79 ± 5.6; P = 0.912). Estimated blood loss was higher in the articulating group, whereas no significant differences were observed in the incidence of postoperative complications. Although articulating instrument did not demonstrate superiority over conventional instruments, it may be considered for use during suprapancreatic lymph node dissection depending on the patient’s anatomy. Further studies are needed to better define its role in laparoscopic gastrectomy and its impact on overall surgical outcome.