title: Robot-assisted gastrectomy for gastric cancer: current status and technical considerations.
abstract: BACKGROUND
  Robot-assisted gastrectomy has been reported as a safe alternative to the conventional laparoscopy or open approach for treating early gastric carcinoma. To date, however, there are a limited number of published reports available in the literature.
  
  
  METHODS
  We assess the current status of robotic surgery in the treatment of gastric cancer, focusing on the technical details and oncological considerations.
  
  
  RESULTS
  In gastric surgery, the biggest advantage of robotic surgery is the ease and reproducibility of D2-lymphadenectomy. Reports show that even the intracorporeal digestive restoration is facilitated by use of the robotic approach, particularly following total gastrectomy. Additionally, the accuracy of robotic dissection is confirmed by decreased blood loss, as reported in series comparing robot-assisted with laparoscopic gastrectomy. The learning curve and technical reproducibility also appear to be shorter with robotic surgery and, consequently, robotics can help to standardize and diffuse minimally invasive surgery in the treatment of gastric cancer, even in the later stages. This is important because the application of minimally invasive surgery is limited by the complexity of performing a D2-lymphadenectomy. The potential to reproduce D2-lymphadenectomy, enlarged resections, and complex reconstructions provides robotic surgery with an important role in the therapeutic strategy of advanced gastric cancer.
  
  
  CONCLUSIONS
  While published reports have shown no significant differences in surgical morbidity, mortality, or oncological adequacy between robot-assisted and conventional laparoscopic gastrectomy, more studies are needed to assess the indications and oncological effectiveness of robotic use in the treatment of gastric carcinoma. Herein, the authors assess the current status of robotic surgery in the treatment of gastric cancer, focusing on the technical details and oncological considerations.
authors.affiliation: Department of General Surgery, Misericordia Hospital, Grosseto, Italy, corattian@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Coratti
authors.forename: Mario
authors.initials: M
authors.lastname: Annecchiarico
authors.forename: Michele
authors.initials: M
authors.lastname: Di Marino
authors.forename: Edoardo
authors.initials: E
authors.lastname: Gentile
authors.forename: Francesco
authors.initials: F
authors.lastname: Coratti
authors.forename: Pier Cristoforo
authors.initials: PC
authors.lastname: Giulianotti
mesh_terms: D000005:Abdomen; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D059032:Learning Curve; D008197:Lymph Node Excision / Q000379:methods*; D015203:Reproducibility of Results; D012371:Robotics / Q000379:methods*; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome