Robotic gastrectomy for gastric cancer

Since the first application of laparoscopic surgery for gastric cancer was performed, radical gastrectomy with minimally invasive approach has gained popularity worldwide. However, due to technically demanding procedures of conventional laparoscopic gastrectomy with D2 lymphadenectomy, adoption of laparoscopic gastrectomy for advanced gastric cancer has been limited. To overcome this technical difficulty, several surgeons started the robotic gastrectomy for gastric cancer using the da Vinci^® Surgical System (Intuitive Surgical, Sunnyvale, CA, USA). Advantages of robotic surgery for surgeons such as articulating EndoWrist^® instruments, an improved 3D magnified operative view, and tremor filtering facilitate more precise and delicate lymph node dissection compared to conventional laparoscopic surgery. Although several retrospective and small prospective studies revealed the feasibility and safety of robotic gastrectomy for gastric cancer, advantages of robotic gastrectomy from an oncologic point of view are still to be clarified. Here, we documented our current practice of robotic surgery for gastric cancer and review of the literatures, as well as the potential advantages of robotic approach, especially for D2 lymphadenectomy.