Reduced-port totally robotic distal subtotal gastrectomy with lymph node dissection for gastric cancer: a modified technique using Single-Site^® and two additional ports

Background: Reduced-port laparoscopic gastrectomy further minimizes the invasiveness of laparoscopic gastrectomy, thereby improving patient quality of life. However, suboptimal ergonomics and visualization are challenges to performing reduced-port laparoscopy. As the application of a robotic surgical system may help overcome these challenges, the present study was performed to evaluate the short-term outcomes of reduced-port totally robotic distal subtotal gastrectomy. Method: An initial 40 consecutive gastric cancer patients treated with reduced-port totally robotic distal subtotal gastrectomy with lymph node dissection from February 2016 to February 2017 were retrospectively reviewed. An overturned infraumbilical Single-Site^® port and two additional abdominal ports were utilized. Clinicopathological characteristics and short-term surgical outcomes were analyzed to evaluate the safety and feasibility of the procedure. Result: Patients comprised 23 (57.5%) males and 17 females. Mean age and body mass index were 54 years and 23.7 kg/m², respectively. Preoperative clinical T stage was early in 22 patients and advanced (T2 or more) in 18 (45%) patients. No conversions to laparoscopic or open surgery and no additional port insertions were required. Eighteen patients (45%) underwent D2 lymph node dissection. All reconstructions after gastrectomy were made intracorporeally, including 34 (85%) Billroth I anastomoses. Mean operative time and blood loss were acceptable (210 min and 49.9 ml, respectively). The mean number of retrieved lymph nodes was 58.8. Postoperative clinical courses were acceptable for all patients, with no grade III or higher complications recorded. Conclusion: Reduced-port totally robotic distal subtotal gastrectomy with lymph node dissection was successfully applied and provided acceptable short-term postoperative results.