A New Surgical Field Expansion Technique in Robot-Assisted Gastrectomy: "Bursal Space Lifting Approach"

Achieving stable exposure in the deep upper stomach remains technically challenging during robot-assisted gastrectomy, particularly in single-port surgery where the range of traction and assistant instrumentation is inherently limited.

We developed a simple surgical field expansion method, termed the "Bursal Space Lifting Approach," based on the integration of established anatomical dissection planes routinely used in gastrectomy. After opening the omental bursa, a soft gauze strip with attached sutures is passed through the created pathway and gently pulled ventrally extracorporeally, elevating the stomach and dorsal mesogastrium without direct tissue grasping. This maneuver creates a curtain-like operative field and provides stable, adjustable traction while preserving robotic working instruments for precise dissection in deep anatomical regions.

Because this technique relies solely on familiar surgical steps and commonly available materials, it is readily reproducible without specialized devices. It is particularly advantageous in the da Vinci SP system, where wide exposure cannot always be achieved using robotic traction alone, although the concept may also be applicable to multiport procedures.