Optimising Robotic Radical Gastrectomy: A Technical Roadmap for Bipolar Forceps-Assisted Lymphadenectomy and...

Robotic surgeries offer technical advantages over laparoscopic surgery, including enhanced precision and ergonomics. However, optimal utilisation requires overcoming the 'carryover effect' of laparoscopic habits and adapting techniques to the robotic platform's unique capabilities. Here we introduce an approach regarding robotic gastrectomy, focusing on instrument selection and lymphadenectomy.

This technical report synthesises our experience with robotic gastrectomy. Key innovations include: (1) preferential use of Maryland bipolar forceps for lymphadenectomy; (2) a robotic-specific lymphadenectomy sequence prioritising gravity-assisted exposure; and (3) intracorporeal hand-suturing anastomosis to minimise stapler dependence.

The Maryland bipolar forceps enabled safer dissection with reduced thermal injury risk. The proposed lymphadenectomy sequence (initiating with cardia mobilisation and concluding with infrapyloric dissection) improved field consolidation and reduced instrument repositioning. Robotic suturing achieved satisfied anastomotic integrity.

A deliberate transition from laparoscopic to robotic techniques optimises outcomes in the robotic era. This framework may accelerate the learning curve for novice robotic surgeons.