Initial Clinical Experience and Technical Insights in Single-Port Robotic Gastrectomy: A Consecutive Case Series...

Single-port (SP) robotic gastrectomy (SPRG) using the da Vinci SP system is an emerging minimally invasive technique, but evidence regarding its safety and feasibility remains limited. This study reports early clinical outcomes and technical insights from a consecutive series of single-port robotic distal gastrectomy (spRDG) for gastric cancer.

Nine patients with resectable gastric cancer underwent spRDG using a subumbilical vertical approach with a single 25-mm SP port and a plus-one assistant port. Lymphadenectomy (LND) (D1 + or D2) followed Korean Gastric Cancer Association (KGCA) guidelines, and intracorporeal Billroth I, Billroth II, or Roux-en-Y reconstruction was performed. A standardized postoperative pathway was used. Perioperative variables, pathology, and textbook outcomes (TO) were assessed.

All procedures were completed without conversion. Median operative time was 265 minutes (range, 181-390), console time 220 minutes (166-330), and estimated blood loss 30 mL (20-50). Intracorporeal reconstruction was successful in all patients. Six patients received D1 + dissection, and 3 received D2. R0 resection was obtained in all cases, with a mean of 30.2 retrieved lymph nodes and no metastatic nodes. TO was achieved in 8 patients (88.9%). The single TO failure occurred in a patient with a recent transurethral prostatectomy, who developed persistent hematuria requiring urologic care and prolonged hospitalization.

Early experience demonstrates that spRDG is feasible, safe, and oncologically adequate in appropriately selected patients. Successful implementation requires familiarity with platform-specific ergonomics and workflow. Until supported by larger studies, indications should remain focused on distal gastrectomy requiring D1 + LND.