Single-port robotic gastrectomy in gastric cancer: a narrative review on the state of the art and outlook

Abstract

Minimally invasive surgery for gastric cancer has progressed from conventional laparoscopy to reduced-port and single-incision techniques, and further to robotic systems that address ergonomic and technical constraints. Reduced-port laparoscopic gastrectomy and single-incision laparoscopic gastrectomy demonstrated feasibility and cosmetic advantages but faced inherent limitations-restricted triangulation, instrument collisions, and unstable visualization-resulting in steep learning curves and selective adoption. Reduced-port robotic platforms, notably Single-Site (Intuitive Surgical)-based reduced-port totally robotic distal gastrectomy, mitigated some limitations and enabled complex tasks, including D2 lymphadenectomy and intracorporeal anastomosis, with acceptable short-term outcomes. The da Vinci Single-Port (SP) system (Intuitive Surgical) represents the latest step in this trajectory, introducing three fully-wristed instruments and a flexible 3-dimensional endoscope through a single multichannel cannula, restoring internal triangulation and reducing collisions. Early clinical experiences from high-volume centers report no or low conversion rates, minimal blood loss, adequate lymph node retrieval, and acceptable morbidity across distal and selected total gastrectomies. Practical considerations for safe adoption include optimized port placement, deliberate scope orientation, and close collaboration with an experienced bedside assistant. Nonetheless, the platform's current lack of integrated robotic staplers and advanced energy or suction devices limits console autonomy; most cases still require an assistant port. Evidence remains confined largely to small series without head-to-head trials against reduced-port multi-arm robotic approaches. Future priorities include SP-dedicated energy and stapling tools, careful expansion to complex procedures, and robust multicenter studies assessing long-term oncologic outcomes. Taken together, the SP platform can be regarded as the present pinnacle of reduced-port gastrectomy and a promising path toward a reproducible, cosmetically favorable, and ergonomically enhanced approach for gastric cancer surgery. [Ann Surg Treat Res 2026;110(1):26-34]