Laparoscopic vs Robotic Gastrectomy for Cancer

Laparoscopic gastrectomy for cancer is a minimally invasive, oncologically safe, and effective procedure, particularly for early-stage gastric cancer. Robotic gastrectomies are a minimally invasive, robot-assisted procedure used to remove part or all of the stomach, a procedure that has recently emerged in the medical world and is rivaling laparoscopic gastrectomy in efficiency and safety as a treatment for cancer.

How do the two procedures work? In short, a laparoscopic gastrectomy consists of the surgeon making several small abdominal incisions to insert a laparoscope, a special camera, and tools to remove the tumor, which all happens under general anesthesia. A robotic gastrectomy is greatly similar, but with the addition of using the assistance of robotics to offer superior 3D, high-definition visualization and increased dexterity compared to traditional laparoscopy. This is achieved as the surgeon controls the technology of a da Vinci Surgical System from a console, translating hand movements into precise, micro-movements of robotic instruments. It is particularly beneficial for complex, tight-space maneuvers, such as D2 lymph node dissection.

How do the two procedures differ? Laparoscopic gastrectomy holds the records for shorter operative times and reduced costs for patients, which is ideal for standard, distal, and straightforward gastrectomies. However, it also holds limited instrument dexterity, providing only 2D view, increasing the potential for greater surgeon fatigue. On the other hand, robotic gastrectomies provide better tremor filtration, increased flexibility, and enhanced 3D visualization, aiding in elevating precision particularly in difficult locations. Its precision allows for less blood loss, less pain, and thus a shorter recovery period, which along with its comparable long term survival rates, may make it a more favorable option. However, the procedure typically has a longer operative time due to robotics setup and manoeuvring involved, thus also leading to higher hospital costs.

Overall, both gastrectomies show equivalent results in terms of total lymph nodes retrieved, tumor-free margins, and short-term survival rates, but robotic gastrectomy demonstrates quicker recovery with reduced overall complications and shorter rehabilitation times. For now, both procedures show great outcomes with 95% and 97% in success rates, and thus the decision between the two stays up to the surgeon's discretion regarding each patient's respective situations.

Written by Renne Wang at Incisionary

References

Columbia Surgery. (n.d.). Gastric Cancer Care Program. Robotic Gastrectomy. https://columbiasurgery.org/conditions-and-treatments/robotic-gastrectomy

Brenkman, H. J., Correa-Cote, J., Ruurda, J. P., & van Hillegersberg, R. (2016). A Step-Wise Approach to Total Laparoscopic Gastrectomy with Jejunal Pouch Reconstruction: How and Why We Do It. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 20(11), 1908–1915. https://doi.org/10.1007/s11605-016-3235-7 

Mirza, W., Cheema, Y. I., Khan, H. M., Ahmad, E., Dadan, S., & Nadeem, M. A. (2025). Robotic versus laparoscopic gastrectomy for gastric cancer: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials on operative metrics, lymphadenectomy, and postoperative complications. Journal of robotic surgery, 19(1), 646. https://doi.org/10.1007/s11701-025-02842-z