Perioperative outcomes of a novel laparoscopic-like "3-arm + 2-port" model in robot-assisted distal gastrectomy in patients with resectable, non-metastatic gastric cancer: a randomized controlled trial.

Authors

Yeqian Zhang, Linnelle Stacy T Lao, Xiaoyao Shen, Xiang Xia, Puhua Zhang, Zihang Liu, Junjie Wang, Bo Ni, Zizhen Zhang

Published in

Journal of robotic surgery. Volume 20. Issue 1. Jul 22, 2026. Epub Jul 22, 2026.

Abstract

To compare the perioperative outcomes of a novel laparoscopic-like 3-arm + 2-port and traditional 4-arm + 1-port models in robot-assisted distal gastrectomy with Billroth II reconstruction in patients with resectable, non-metastatic gastric cancer. This randomized controlled trial included patients with resectable, non-metastatic gastric cancer who underwent robot-assisted distal gastrectomy with Billroth II reconstruction with Braun anastomosis and D2 lymphadenectomy. Patients were randomly allocated into two groups based on trocar port placement: traditional 4 + 1 and novel laparoscopic-like 3 + 2 models, using a computer-generated stratified blocked randomization sequence. Outcome measures included operative times, intraoperative blood loss, lymph node yield, postoperative outcomes, and operating room costs. A total of 195 patients were included: 98 in the 3 + 2 group and 97 in the 4 + 1 group. The total operative time was significantly shorter in the 3 + 2 group than in the 4 + 1 group (207.14 ± 22.214 vs. 221.38 ± 26.689 min, p < 0.001). Subsequently, significant reductions in the regional and non-operative times, including omentectomy, stations 4sb, 6, 5/12, 11p/8a/7/9, and 1/3 lymph node dissection, robotic arm docking and switching, and target organ exposure times were also demonstrated in the 3 + 2 group. Significantly more lymph nodes were harvested from station 4sb in the 3 + 2 group (5.26 ± 1.431 vs. 4.70 ± 1.393, p = 0.007). Operating room costs were also significantly lower in the 3 + 2 group (CNY 15,140.56 ± 2,712.21 vs. CNY 18,650.03 ± 1,497.41, p < 0.001). This novel 3 + 2 laparoscopic-like model represents a technically viable and economically advantageous alternative to robot-assisted distal gastrectomy for patients with gastric cancer.

PMID:
42484711
Bibliographic data and abstract were imported from PubMed on 22 Jul 2026.

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