渡邊 祐介

BACKGROUND Gastric cancer (GC) surgery requires comprehensive informed consent (IC), but conventional in-person IC is time-consuming and cognitively demanding. We hypothesized that pre-consultation video IC (PVIC) aids would reduce decisional conflict and consultation time. AIM To evaluate whether supplementing in-person IC with video aids reduces decisional conflict and IC duration, and to determine the optimal timing for video viewing. METHODS In this single-center, randomized controlled trial, 60 patients undergoing gastrectomy for GC were assigned to either the PVIC group or the standard IC (SIC) group (video viewing after consultation). The primary endpoint was the decisional conflict scale (DCS) score. Secondary endpoints included the duration of in-person IC and the proportion of patients experiencing high decisional conflict (DCS ≥ 37.5). Data were analyzed using the t -test, χ 2 test, and Mann-Whitney U test. RESULTS Although the PVIC group showed lower DCS scores than the SIC group, the difference did not reach statistical significance (P = 0.056). However, the prevalence of high decisional conflict was significantly lower in the PVIC group (0% vs 20%; P = 0.024). Furthermore, the duration of in-person IC was significantly shorter in the PVIC group compared to the SIC group (mean difference: 13.5 minutes; P < 0.001). CONCLUSION PVIC aids significantly reduce IC duration and eliminate high decisional conflict. This approach enhances the efficiency and quality of patient education in GC surgery.

BACKGROUND: Single-port surgery offers improved cosmesis but is technically demanding. The da Vinci™ SP (DVSP) system aims to overcome these challenges; however, rigorous data on the comparison between the DVSP system and the standard multi-port da Vinci™ Xi system (DVXi) are scarce. This study aimed to compare the short-term outcomes of the DVSP with those of the DVXi for robotic distal gastrectomy after adjusting for patient selection bias. METHODS: We retrospectively reviewed 311 patients undergoing robotic distal gastrectomy for gastric cancer between March 2023 and December 2024 at two institutions. Based on patient demographics and tumor characteristics, a 1:1 propensity score matching analysis was performed to mitigate bias. After matching, 36 patients in the DVSP group were compared with 36 patients in the DVXi group. Perioperative outcomes, pathological findings, and postoperative complications were analyzed. RESULTS: The DVSP group had significantly shorter median operative time (329 vs. 414 min, p < 0.001) and console time (261 vs. 332 min, p < 0.001). A significantly higher number of lymph nodes were retrieved in the DVSP group (mean 46 vs. 32, p = 0.04). The median postoperative stay exhibited a trend toward being shorter in the DVSP group (11 vs. 12 days, p = 0.08). No conversions to open or multi-port surgery occurred. The incidence of postoperative complications (Clavien-Dindo grade ≥ II) was comparable between the groups (8.3% vs. 16.7%, p = 0.48). CONCLUSIONS: In this study, single-port gastrectomy using the DVSP system was safe and feasible in the short-term outcomes compared with multi-port gastrectomy using the DVXi system.