Surgical Endoscopy

, Volume 29, Issue 3, pp 673–685 | Cite as

Potential advantages of robotic radical gastrectomy for gastric adenocarcinoma in comparison with conventional laparoscopic approach: a single institutional retrospective comparative cohort study

  • Koichi Suda
  • Mariko Man-i
  • Yoshinori Ishida
  • Yuichiro Kawamura
  • Seiji Satoh
  • Ichiro Uyama



We have previously reported that laparoscopic approach improved short-term postoperative courses even for advanced gastric adenocarcinoma, but not morbidity, in comparison with open approach. The objective of this study was to determine the impact of the use of the surgical robot, da Vinci Surgical System, in minimally invasive radical gastrectomy on short-term outcomes.


A single institutional retrospective cohort study was performed (UMIN000011749). Five hundred twenty-six patients who underwent radical gastrectomy were enrolled. Eighty-eight patients who agreed to uninsured use of the surgical robot underwent robotic gastrectomy, whereas the remaining 438 patients who wished for laparoscopic (lap) approach with health insurance coverage underwent conventional laparoscopic gastrectomy.


In the robotic group, morbidity (robotic vs lap 2.3 vs 11.4 %, p = 0.009) and hospital stay following surgery (robotic vs lap 14 [2–31] vs 15 [8–136] days, p = 0.021) were significantly improved, even though operative time (p = 0.003) and estimated blood loss (p = 0.026) were slightly greater. In particular, local (robotic vs lap 1.1 vs 9.8 %, p = 0.007) rather than systemic (robotic vs lap 1.1 vs 2.5 %, p = 0.376) complication rates were attenuated using the surgical robot. Multivariate analyses revealed that non-use of the surgical robot (OR 6.174 [1.454–26.224], p = 0.014), total gastrectomy (OR 4.670 [2.503–8.713], p < 0.001), and D2 lymphadenectomy (OR 2.095 [1.124–3.903], p = 0.020) were the significant independent risk factors determining postoperative complications.


The use of the surgical robot might reduce surgery-related complications, leading to further improvement in short-term postoperative courses following minimally invasive radical gastrectomy.


Gastric cancer Robotic gastrectomy Laparoscopic gastrectomy Complication Pancreatic fistula 





Early gastric cancer


Advanced gastric cancer


Japanese Classification of Gastric Carcinoma


Creatinine clearance


Arterial oxygen pressure


Japanese Gastric Cancer Association


Functional end-to-end anastomosis


Robotic third arm


Robotic first arm


Robotic second arm


Odds ratio


National Comprehensive Cancer Network



The authors wish to express special thanks to Professor Masaki Kitajima for his wonderful supervision of this project. The authors are indebted to Ms. Michelle Paknad for her review of this manuscript.


All the authors (K.S., M.M., Y.I., Y.K., S.S., and I.U.) have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Koichi Suda
    • 1
  • Mariko Man-i
    • 1
  • Yoshinori Ishida
    • 1
  • Yuichiro Kawamura
    • 1
  • Seiji Satoh
    • 1
  • Ichiro Uyama
    • 1
  1. 1.Division of Upper GI, Department of SurgeryFujita Health UniversityToyoakeJapan

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