Evaluating the impact of a navigation system on the initial cases of robotic gastrectomy for gastric cancer.

Abstract

Robotic gastrectomy for gastric cancer presents challenges for novice surgeons owing to the lack of tactile feedback, particularly during complex procedures, such as lymph node dissection. To address these issues, a vascular navigation system was developed to enhance procedural safety and efficiency by providing three-dimensional vascular and anatomical guidance. We retrospectively analyzed 49 patients who underwent robotic distal gastrectomy at Pusan National University Yangsan Hospital. Patients were divided into two groups: those without navigation support (noRUS) and those with a vascular navigation system (RUS). We compared the dissection time, number of lymph nodes (LNs) retrieved, C-reactive protein level on postoperative day 3 (CRPD3), and postoperative recovery status. Univariate and multivariate linear regression analyses were performed. The RUS group demonstrated significantly shorter dissection times (179.85 ± 6.88 vs. 204.87 ± 9.60 min, p = 0.0478) and higher LN retrieval (41.81 ± 2.77 vs. 30.96 ± 2.31, p = 0.0048). The CRPD3, a marker of surgical trauma, was significantly lower in the RUS group (8.27 ± 0.85 vs. 11.68 ± 1.13 mg/dL, p = 0.0184). Moreover, no significant differences were observed in the complication rates or postoperative recovery. The vascular navigation system significantly improved surgical efficiency and LN retrieval and reduced surgical trauma during robotic gastrectomy. This study is the first to evaluate the impact of the navigation system on novice surgeons, highlighting its potential to overcome the learning curve earlier and improve patient outcomes.