Surgical team configuration, technical errors, and workload in robotic distal gastrectomy
Related Experiment Video
Updated: Sep 12, 2026
Robotics in Surgery: A Modular Robotic Platform Driven Gastric Wedge Resection
Published on: February 7, 2025
Debang Zhang1, Junjie Wang1, Yeqian Zhang1
1Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Background:
Robotic distal gastrectomy requires coordinated task allocation between the console surgeon and bedside assistant. Whether a laparoscopic-like "3-arm+2-port" configuration is associated with better technical performance and lower surgical workload compared with the conventional "4-arm+1-port" configuration remains unclear.
Methods:
This single-center prospective cohort study included 84 patients undergoing robotic distal gastrectomy from September 2025 to March 2026. After variable-ratio propensity score matching, 45 patients in the "3-arm+2-port" group and 22 in the "4-arm+1-port" group were analyzed. Technical errors were assessed from operative videos using Observational Clinical Human Reliability Analysis. Workload was evaluated separately for primary surgeons and assistants.
Results:
After matching, covariate balance was substantially improved. The "3-arm+2-port" group had fewer total technical errors than the "4-arm+1-port" group (42.6 (7.2) vs. 52.8 (6.9); P < .001), with significant differences in phase 3 (11.4 (3.5) vs. 15.7 (4.1); adjusted P < .001) and phase 6 (9.0 (2.7) vs. 14.1 (3.0); adjusted P < .001). Grade 2 bleeding, tissue slippage, heat burn, and Hem-o-lok slippage were also less frequent. Overall workload scores were lower for primary surgeons (8 (7-9) vs. 12 (9-13); P < .001) and assistants (6 (5-8) vs. 10 (8.25-11); P < .001). Operative time, docking time, blood loss, and short-term recovery outcomes were more favorable, whereas console time, time-adjusted technical error rate, lymph node harvest, and complications did not differ significantly.
Conclusions:
In robotic distal gastrectomy, the laparoscopic-like "3-arm+2-port" configuration was associated with fewer technical errors, lower team workload, and more favorable short-term recovery, although the time-adjusted technical error rate did not differ significantly. These findings suggest that surgical team configuration is a potentially modifiable factor associated with intraoperative performance and teamwork efficiency.