Robotic Gastrectomy Techniques in Gastric Cancer Management

Robotic gastrectomy has emerged as a sophisticated iteration of minimally invasive surgery for gastric cancer, building on the foundations of laparoscopic techniques and open resection. Employing robotic platforms with three-dimensional vision, wristed instruments and tremor filtration, surgeons can achieve meticulous dissection and reconstruction in confined anatomical spaces. These systems facilitate precise lymphadenectomy around critical vascular structures, notably supporting D2 lymph node removal, which is central to oncological clearance. Clinical experience worldwide has demonstrated key advantages such as reduced intraoperative blood loss, shorter time to oral intake and faster postoperative recovery. Randomized and prospective trials have reported non-inferior or superior disease-free survival compared with conventional laparoscopy, while exploratory studies of single-port approaches aim to minimise incision number and enhance cosmesis. Adoption spans high-volume centres in East Asia and growing programmes in Europe and North America, reflecting global interest in the technology’s capacity to standardise complex gastrectomy. Challenges remain in reducing operative duration, managing costs and refining training pathways to shorten the learning curve. Future directions encompass integration of advanced imaging, enhanced haptic feedback and data-driven optimisation to further refine patient selection and surgical quality.

Research from Nature Portfolio

Randomized comparisons have highlighted that robotic distal gastrectomy may offer improved long-term outcomes. In a phase 2 trial, three-year disease-free survival was higher in the robotic group than in the laparoscopic cohort, with a reduced cumulative recurrence rate. Safety and feasibility have been confirmed in early-phase studies of reduced-port robotic distal gastrectomy using a single-port system, where expert teams achieved zero major complications, minimal blood loss and rapid discharge in selected patients. In analyses focused on advanced gastric cancer, propensity score-matched cohorts undergoing robotic-assisted distal gastrectomy with D2 lymphadenectomy exhibited lower intraoperative blood loss, higher lymph node yield and decreased rates of postoperative pancreatic fistula compared with laparoscopic approaches, affirming the technique’s applicability to more complex cases.

Robotic Gastrectomy Techniques in Gastric Cancer Management publication trend

The graph below shows the total number of articles in robotic gastrectomy techniques in gastric cancer management across all publications each year (not limited to Nature Index journals).

Technical terms

Robotic gastrectomy: Minimally invasive removal of part or all of the stomach for cancer using a robotic surgical system.

Laparoscopic gastrectomy: Minimally invasive stomach resection performed through multiple small abdominal incisions using straight instruments.

D2 lymphadenectomy: Systematic removal of both perigastric and second-tier lymph nodes around major vessels for gastric cancer staging and clearance.

Single-port robotic system: Robotic platform designed to perform surgery through a single incision, reducing the number of ports required.

References

1. Robotic versus laparoscopic distal gastrectomy for resectable gastric cancer: a randomized phase 2 trial. Nature Communications (2024).
2. Safety and feasibility of reduced-port robotic distal gastrectomy for gastric cancer: a phase I/II clinical trial using the da Vinci Single Port(SP) robotic system. Scientific Reports (2023).
3. Robotic versus laparoscopic Gastrectomy for gastric cancer: a systematic review and updated meta-analysis. BMC Surgery (2017).
4. Robotic-assisted gastrectomy for gastric cancer: a European perspective. Gastric Cancer (2019).
5. Robotic- versus laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer based on propensity score matching: short-term outcomes at a high-capacity center. Scientific Reports (2020).