Reduced-Ports Robotic Pylorus-Preserving Gastrectomy for Gastric Cancer.

Background: Laparoscopic gastrectomy has proven to be safe and effective as a first-line treatment for early gastric cancer in terms of oncologic results. The da Vinci robotic system offers stable 3D vision, near-infrared fluorescence imaging, and articulating wrist movements, making it suitable for performing reduced-ports robotic pylorus-preserving gastrectomy (RP-RPPG). This study examines the feasibility and safety of RP-RPPG for gastric cancer.

Methods: Patients who underwent RP-RPPG at a single institution from March 2019 to October 2023 were enrolled. Electronic medical records were retrospectively reviewed for operative time, estimated blood loss (EBL), retrieved number of lymph nodes, postoperative hospital course, and early complications. Learning curve using operation time was analyzed through cumulative sum (CUSUM) and segmental analysis methods.

Results: Among the 79 patients included, the median operation time was 175.0 (66.0) minutes, and estimated blood loss was 10.0 (25.0) mL. Early complications occurred in 6 patients (7.6%), but all were managed conservatively without needing invasive intervention. Among them, delayed gastric emptying was observed in 3 patients (3.8%). The learning curve analysis indicated a proficiency threshold after the 38th procedure, aligning with a subsequent decrease in operative times as the surgeon's experience progressed.

Conclusion: RP-RPPG is feasible and can be performed safely by an experienced surgeon without increasing early postoperative morbidity.