• Gastrectomy
• Gastric cancer
• Laparoscopy
• Learning curve
• Minimally invasive surgical procedures

• Gastrectomy/methods
• Gastrectomy/education
• Laparoscopy/methods
• Laparoscopy/education
• Learning Curve
• Humans
• Robotic Surgical Procedures/education
• Robotic Surgical Procedures/methods
• Stomach Neoplasms/surgery

• Gastrectomy
• Gastric cancer
• Laparoscopy
• Learning curve
• Minimally invasive surgical procedures

• Humans
• Gastrectomy/methods
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Learning Curve
• Postoperative Complications/etiology
• Retrospective Studies
• Robotic Surgical Procedures/methods
• Stomach Neoplasms/surgery
• Stomach Neoplasms/complications
• Treatment Outcome

• Gastric cancer
• Laparoscopic surgery
• Reduced-port laparoscopic surgery
• Single-incision plus one port
• Single-incision plus two ports
• Total gastrectomy

• FPLDG
• TPLDG
• distal gastrectomy
• gastric cancer
• laparoscopic surgery

• gastrectomy
• overweight
• reduced port laparoscopic surgery

Reduced-port laparoscopic gastrectomy can potentially reduce postoperative pain and improve recovery time. However, the inherent difficulty caused by the narrow manipulation angle makes this operation difficult, especially during lymph node dissection. The intrinsic advantage of the da Vinci^® robotic system might offset this difficulty, maintaining adequate surgical quality with risks of surgical complications equal to those by the conventional four-port robotic approach. The aim of this study was to compare the reduced-port robotic approach and the conventional four-port approach in terms of postoperative pain and short-term surgical outcomes.

All patients who underwent radical gastrectomy with D2 lymph node dissection using the da Vinci Xi robotic system, including reduced-port or conventional four-port approach, were analyzed retrospectively. The primary outcome was postoperative pain assessed using the numerical rating scale (NRS). The secondary outcomes were the number of harvested lymph nodes, operation time, length of hospital stay, and postoperative 30-day complications.

Forty-eight patients were enrolled in the study, 10 cases in the reduced-port and 38 in the conventional four-port group. Postoperative NRS revealed no significant difference between the reduced-port and conventional four-port groups [postoperative day (POD) 1: 4.5 vs. 3, p = 0.047, POD 3: 4 vs. 3, p = 0.178]. After propensity score matching, there were no significant differences in the median number of harvested lymph nodes, operation time, and length of hospital stay between the groups. The postoperative 30-day complications were more frequent in the conventional four-port group, but there was no significant difference compared with the reduced-port group after propensity score matching.

Reduced-port robotic gastrectomy with D2 lymph node dissection might be comparable to the conventional four-port robotic operation in terms of postoperative pain, surgical quality, and short-term outcomes. However, further studies are required to confirm our results and clarify the advantages of the robotic reduced-port approach.

• Gastrectomy
• Gastric cancer
• Lymph node dissection
• Robotic surgery

• Gastrectomy
• Hospital costs
• Minimally invasive surgery
• Propensity score matching

• Humans
• Stomach Neoplasms/surgery
• Stomach Neoplasms/complications
• Gastrectomy/methods
• Gastrectomy/adverse effects
• Female
• Male
• Laparoscopy/methods
• Middle Aged
• Obesity/complications
• Obesity/surgery
• Aged
• Retrospective Studies
• Treatment Outcome
• Postoperative Complications/etiology
• Postoperative Complications/epidemiology
• Operative Time
• Body Mass Index

• Gastrectomy
• Gastric cancer
• Novice surgeon
• Reduced port

Intracorporeal esophagojejunostomy during reduced-port gastrectomy for proximal gastric cancer is a technically challenging technique. No study has yet reported a robotic technique for anastomosis. Therefore, to address this gap, we describe our reduced-port technique and the short-term outcomes of intracorporeal esophagojejunostomy.

We conducted a retrospective review of patients who underwent a totally robotic reduced-port total or proximal gastrectomy between August 2016 and March 2020. We used an infra-umbilical Single-Site^® port with two additional ports on both sides of the abdomen. To transect the esophagus, a 45-mm endolinear stapler was inserted via the right abdominal port. The common channel of the esophagojejunostomy was created between the apertures in the esophagus and proximal jejunum using a 45-mm linear stapler. The entry hole was closed with a 45-mm linear stapler or robot-sewn continuous suture. All anastomoses were performed without the aid of an assistant or placement of stay sutures.

Among the 40 patients, there were no conversions to open, laparoscopic, or conventional 5-port robotic surgery. The median operation time and blood loss were 254 min and 50 mL, respectively. The median number of retrieved lymph nodes was 40.5. The median time to first flatus, soft diet intake, and length of hospital stay were 3, 5, and 7 days, respectively. Three (7.5%) major complications, including two anastomosis-related complications and a case of small bowel obstruction, were treated with an endoscopic procedure and re-operation, respectively. No mortality occurred during the study period.

Intracorporeal esophagojejunostomy during reduced-port gastrectomy can be safely performed and is feasible with acceptable surgical outcomes.

• Robot surgery
• Roux-en-Y anastomosis
• Stomach cancer

• Articulating device
• Gastrectomy
• Gastric cancer
• Single-port surgery

• National Research Foundation of Korea
• Korea University

Various studies have indicated that reduced-port robotic gastrectomies are safe and feasible for treating patients with early gastric cancer. However, there have not been any comparative studies conducted that have evaluated patients with clinically advanced gastric cancer. Therefore, we aimed to compare the perioperative outcomes of D2 lymph node dissections during reduced-port robotic distal subtotal gastrectomies (RRDGs) and conventional 5-port laparoscopic distal subtotal gastrectomies (CLDGs).

We retrospectively evaluated 118 patients with clinically advanced gastric cancer who underwent minimally invasive distal subtotal gastrectomies with D2 lymph node dissections between February 2016 and November 2019. To evaluate the patient data, we performed a 1:1 propensity score matching (PSM) according to age, sex, body mass index, American Society of Anesthesiologists physical status classification score, and clinical T status. The short-term surgical outcomes were also compared between the two groups.

The PSM identified 40 pairs of patients who underwent RRDG or CLDG. The RRDG group experienced a significantly longer operation time than the CLDG group (P<0.001), although the RRDG group had significantly less estimated blood loss (P=0.034). The number of retrieved extraperigastric lymph nodes in the RRDG group was significantly higher than that of the CLDG group (P=0.008). The rate of postoperative complications was not significantly different between the two groups (P=0.115).

D2 lymph node dissections can be safely performed during RRDGs and the perioperative outcomes appear to be comparable to those of conventional laparoscopic surgeries. Further studies are needed to compare long-term survival outcomes.

• Gastrectomy
• Lymphadenectomy
• Robotic surgical procedures
• Stomach neoplasms

Single incision plus one port left-side approach (SILS+1/L) totally laparoscopic distal gastrectomy (TLDG) is an emerging technique for the treatment of gastric cancer. Reduced port laparoscopic gastrectomy has a number of potential advantages for patients compared with conventional laparoscopic gastrectomy: relieving postoperative pain, shortening hospital stay and offering a better cosmetic outcome. Nevertheless, there are no previous reports on the use of SILS+1/L TLDG with uncut Roux-en-Y (uncut R-Y) reconstruction.

To investigate the initial feasibility of SILS+1/L TLDG with uncut Roux-en-Y digestive tract reconstruction (uncut R-Y reconstruction) to treat distal gastric cancer.

A total of 21 patients who underwent SILS+1/L TLDG with uncut R-Y reconstruction for gastric cancer were enrolled. All patients were treated at The Second Hospital of Shandong University. Reconstructions were performed intracorporeally with 60 mm endoscopic linear stapler and 45 mm no-knife stapler. The clinicopathological characteristics, surgical details, postoperative short-term outcomes, postoperative follow-up upper gastrointestinal radiography findings and endoscopy results were analyzed retrospectively.

All SILS+1/L operations were performed by SILS+1/L TLDG successfully. The patient population included 13 men and 8 women with a mean age of 48.2 years (ranged from 40 years to 70 years) and median body mass index of 22.8 kg/m². There were no conversions to open laparotomy, and no other port was placed. The mean operation time was 146 min (ranged 130-180 min), and the estimated mean blood loss was 54 mL (ranged 20-110 mL). The mean duration to flatus and discharge was 2.3 (ranged 1-3.5) and 7.3 (ranged 6-9) d, respectively. The mean number of retrieved lymph nodes was 42 (ranged 30-47). Two patients experienced mild postoperative complications, including surgical site infection (wound at the navel incision) and mild postoperative pancreatic fistula (grade A). Follow-up upper gastrointestinal radiography and endoscopy were carried out at 3 mo postoperatively. No patients experienced moderate or severe food stasis, alkaline gastritis or bile reflux during the follow-up period. No recanalization of the biliopancreatic limb was found.

SILS+1/L TLDG with uncut R-Y reconstruction could be safely performed as a reduced port surgery.

• Laparoscopy
• Distal gastrectomy
• Single-incision plus one port
• Uncut Roux-en-Y gastrojejunostomy
• Reduced port surgery
• Gastric cancer

• Adult
• Anastomosis, Roux-en-Y/adverse effects
• Female
• Gastrectomy/adverse effects
• Humans
• Laparoscopy/adverse effects
• Male
• Retrospective Studies
• Stomach Neoplasms/diagnostic imaging
• Stomach Neoplasms/surgery
• Treatment Outcome

• Minimally invasive surgery (MIS)
• early gastric cancer (EGC)

• Gastric cancer
• Lymphadenectomy
• Robotic gastrectomy

• Adult
• Aged
• Female
• Gastrectomy/instrumentation
• Gastrectomy/methods
• Humans
• Laparoscopy/instrumentation
• Length of Stay
• Lymph Node Excision/instrumentation
• Lymph Node Excision/methods
• Male
• Middle Aged
• Operative Time
• Postoperative Complications/epidemiology
• Prognosis
• Robotic Surgical Procedures/instrumentation
• Robotic Surgical Procedures/methods
• Stomach Neoplasms/surgery

• Dual-port laparoscopic distal gastrectomy
• Gastric cancer
• Initial experience
• Single-arm study

• Adult
• Aged
• Female
• Gastrectomy/methods
• Humans
• Laparoscopy/methods
• Length of Stay
• Lymph Node Excision
• Male
• Middle Aged
• Operative Time
• Postoperative Period
• Retrospective Studies
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery

• 2017YFC0108300 the State's Key Project of Research and Development Plan
• 81672446 the National Natural Science Foundation of China
• 2014A020215014 Guangdong Provincial Science and Technology Key Project
• 201402015 the National Health and Family Planning Commission of China
• LC2016ZD003 the Southern Medical University Clinical Research Start-Up Project
• [2012]121 the Key Clinical Specialty Discipline Construction Program

• Gastric cancer
• Laparoscopy
• Meta-analysis
• Total gastrectomy

• Roux-en-Y anastomosis
• gastrectomy
• minimally invasive surgical procedures
• stomach neoplasms

• Gastrectomy
• Laparoscopy
• Learning curve
• Stomach neoplasms

• early gastric cancer
• outcomes
• propensity score matching analysis
• reduced port laparoscopic gastrectomy
• three-port laparoscopic gastrectomy