Comparative analysis of subcutaneous emphysema and port site damage between robotic platforms in gastrectomy

Robotic gastrectomy (RG) is increasingly adopted for the treatment of gastric cancer due to its technical advantages. However, specific complications such as subcutaneous emphysema (SE) and port site dilation (PSD) may arise due to pneumoperitoneum and trocar manipulation. This study aimed to investigate the incidence and risk factors of SE and PSD, with a focus on differences between robotic platforms.

This retrospective study included 126 patients who underwent RG between April 2021 and April 2025. SE was defined as subcutaneous gas extending to the anterior chest wall on postoperative day 1. PSD was evaluated using intraoperative videos and defined as a visible gap between the trocar and abdominal wall. Multivariable logistic regression was performed to identify independent predictors of SE and PSD, including robotic system type (da Vinci Xi vs. hinotori^™).

SE and PSD were observed in 20 (15.9%) and 21 (16.7%) patients, respectively. The use of the hinotori^™ was independently associated with a lower incidence of SE (OR: 0.085, 95% CI: 0.01-0.70, p = 0.02) and PSD (OR: 0.089, 95% CI: 0.016-0.39, p = 0.001). No significant association was found between SE or PSD and postoperative complications of Clavien-Dindo grade ≥ II or ≥ III.

The docking-free hinotori^™ platform significantly reduced the incidence of SE and PSD compared to the da Vinci Xi. Recognizing the mechanical features of each robotic system and tailoring platform selection to patient and procedural factors may improve surgical outcomes.