Generalized applicability of da Vinci SP for gastrectomy considering from short-term outcomes, learning curve, and reproducibility.

Abstract

365 Background: Robot-assisted gastrectomy using da Vinci Xi is increasingly adopted as a minimally invasive approach for gastric cancer. Recently, single port robot, da Vinci SP, was introduced in gastrectomy in some specialized hospitals. Our institution introduced da Vinci Xi system in August 2019 and subsequently implemented da Vinci SP system in May 2024. From the first SP case, we applied fusion surgery, which combines single-port robotic surgery with multiple assistant ports. The most critical concern in adopting a new robotic platform is the potential risk to patients during the initial implementation phase. This study aimed to evaluate whether SP can be safely generalized in Xi-experienced centers by analyzing short-term outcomes, the presence of a learning curve, and inter-surgeon reproducibility. Methods: We retrospectively analyzed 152 consecutive patients who underwent robot-assisted distal gastrectomy (RDG) at our institution between August 2019 and April 2025, including 122 cases with Xi-RDG and 30 cases with SP-RDG. Patient characteristics, perioperative outcomes, and short-term results were compared between groups. Sequential case analysis was performed to identify potential learning curves for both groups. Additionally, reproducibility between two surgeons was specifically evaluated in the SP group. Results: Baseline patient characteristics were comparable between the two groups. Compared with Xi-RDG, SP-RDG showed significantly less blood loss (13.5 vs 33 ml, p<0.001), shorter operative time (196 vs 307 min, p<0.001), and shorter console time (158 vs 261 min, p<0.001). The number of retrieved lymph nodes, postoperative hospital stay, and incidence of Clavien-Dindo grade ≥II complications were similar. Two cases of pneumonia occurred in the SP group, but no mortality or other life-threatening complications were observed. Sequential case analysis demonstrated no learning curve for SP-RDG, and reproducibility of surgical performance was confirmed between the two surgeons. Conclusions: SP-RDG can be introduced in Xi-experienced institutions without imposing additional risks or requiring a new learning curve. Furthermore, reproducibility was validated across different surgeons. SP contributed to significant reductions in operative and console times compared with Xi. Considering these, generalized applicability of da Vinci SP for gastrectomy would be high.