Single-incision robot-assisted distal gastrectomy for gastric cancer (FUTURE-05): short-term outcomes of a...

Gastrectomy has evolved significantly with advancements in minimally invasive surgery, particularly with the advent of single-incision laparoscopic surgery (SILS). Despite its benefits, SILS faces challenges related to instrument crowding and loss of triangulation. Robotic assistance in SILS, known as single-incision robotic-assisted surgery (SIRAS), may overcome these issues, offering greater precision and maneuverability. This study aimed to explore the technical feasibility and safety of SIRAS for distal gastrectomy using the SHURUI System (SR-ENS-600).

A cohort of 13 gastric cancer patients who underwent SIRAS between February and June 2024 were compared with a retrospective group of 25 patients who underwent multi-port robotic-assisted surgery (RAS) between September 2019 and May 2020. The primary endpoints were to evaluate surgical outcomes, including operation time, blood loss, lymph node retrieval, complications, postoperative recovery, and surgical task load.

The mean (SD) surgical time for SIRAS was 287.00 (39.83) minutes, significantly longer than the RAS group (258.84[38.23]) (P = 0.041). The SIRAS group exhibited higher times for docking (P < 0.001) and lymph node dissection (P = 0.003). There were no significant differences in blood loss and lymph node retrieval between the two groups (P > 0.05). There was no short-term postoperative complication reported in the SIRAS group. One patient in the RAS group experienced intra-abdominal infection, and another patient in the RAS group had postoperative bleeding. The SIRAS group had lower postoperative pain scores (P = 0.011) and higher quality-of-life scores (P = 0.05) than the RAS group, while the first assistant had higher physical fatigue (P = 0.04).

SIRAS using the SR-ENS-600 system for distal gastrectomy is technically feasible and safe. Despite some challenges, it offers advantages in terms of reduced postoperative pain and improved quality of life. The small sample size of this initial experience limits the generalizability of the findings, and larger-scale studies are warranted.