ABSTRACT
Background
Robotic gastrectomy has been adopted for gastric cancer. However, operative time remains longer than that of laparoscopic surgery. Junk time has been proposed as a major contributor to prolonged operative duration. This study evaluated intraoperative time structure during the initial clinical experience with the minimally invasive laparoscopic and robotic (MILAR) approach using the da Vinci SP system.
Methods
This retrospective exploratory workflow analysis included consecutive patients who underwent robot‐assisted distal gastrectomy with D1+/D2 lymphadenectomy between May 2024 and June 2025. Patients were divided into the SP (MILAR) group and the conventional multi‐port robotic (Xi) group. Operative videos from skin incision to gastric transection were reviewed to quantify effective time and junk time.
Results
A total of 40 patients were analyzed (SP, n = 11; Xi, n = 29). Total operative time was significantly shorter in the SP group than in the Xi group (148.0 vs. 204.0 min, p = 0.001). Junk time was significantly reduced (30.4 vs. 36.6 min, p = 0.034), accompanied by fewer robotic instrument exchanges (4 vs. 46, p < 0.001). Effective time was shorter in the SP group; although this finding may have been influenced by surgeon expertise and case complexity. No increase in procedure‐related complications was observed in the SP group.
Conclusions
The present exploratory study describes differences in intraoperative time structure observed during the initial clinical experience with the MILAR approach using SP system. These findings provide insight into workflow characteristics of a hybrid team‐based approach and warrant further evaluation in prospective studies.
Keywords: da Vinci SP, intraoperative time structure, junk time, MILAR, robotic gastrectomy, single‐port surgery
1. Introduction
Robotic gastrectomy has been increasingly adopted for the treatment of gastric cancer due to its technical advantages, including three‐dimensional visualization, tremor filtration, and articulated instruments. Previous meta‐analyses have demonstrated that robotic gastrectomy is associated with reduced intraoperative blood loss [1, 2], lower rates of severe complications [1], and fewer pancreatic‐related complications compared with laparoscopic gastrectomy [2]. As a result, the use of robotic systems in gastric cancer surgery has rapidly expanded in recent years. However, robotic gastrectomy is generally associated with longer operative times than laparoscopic surgery, which has been attributed to time‐consuming intraoperative processes such as instrument exchange and system adjustment.
From the perspective of surgical workflow, these time‐consuming processes have been conceptualized as “junk time,” defined as non‐productive intraoperative time that does not directly contribute to surgical progress [3]. A previous study has suggested that the prolonged operative time in robotic gastrectomy is largely attributable to increased junk time caused by frequent instrument exchanges, robotic arm adjustments, and workflow interruptions. Therefore, analysis of intraoperative time structure, including both productive and non‐productive components, may provide deeper insight into intraoperative workflow beyond total operative time alone. Although the concept of junk time has not yet been extensively validated across different robotic procedures, it may provide a useful perspective for exploratory assessment of intraoperative workflow.
The da Vinci SP (single‐port) system is a novel robotic platform that enables the insertion of three articulated instruments and a three‐dimensional endoscope through a single incision. Compared with conventional multi‐port robotic systems, the SP system provides a wider working space for assistant surgeons and allows flexible manipulation using multi‐joint instruments and an articulated camera. These features may influence intraoperative workflow and instrument handling during robotic gastrectomy.
Based on these characteristics, we previously developed a hybrid surgical approach termed minimally invasive laparoscopic and robotic surgery (MILAR), which combines the SP robotic system with conventional laparoscopic techniques [4]. In this approach, the robotic operator uses three instruments, while the laparoscopic assistant uses two additional forceps, enabling stable and optimal exposure through multi‐directional traction. Furthermore, the active use of laparoscopic devices allows essential surgical steps such as vessel sealing and transection to be performed without relying solely on robotic instruments. In our previous study, this approach demonstrated favorable short‐term outcomes, including minimal blood loss, acceptable operative times, and low postoperative morbidity, supporting its feasibility and safety in gastric cancer surgery [5].
We hypothesized that these workflow characteristics of the MILAR approach may influence intraoperative time structure, particularly nonproductive time related to robotic instrument exchange, which has been proposed as an important contributor to intraoperative inefficiency. Despite these theoretical advantages, the mechanism by which such a hybrid approach may influence operative workflow has not been quantitatively evaluated. In particular, little is known about how hybrid robotic workflows influence intraoperative time structure during robotic gastrectomy.
Therefore, the present study aimed to investigate intraoperative time structure during robotic distal gastrectomy using the MILAR approach with the da Vinci SP system, with particular focus on non‐productive intraoperative time (“junk time”) and robotic instrument exchange.
2. Methods
2.1. Study Design and Patients
This retrospective study included consecutive patients who underwent robot‐assisted distal gastrectomy for gastric cancer at our institution between May 2024 and June 2025. Eligible patients were those who underwent distal gastrectomy with D1+ or D2 lymphadenectomy followed by Roux‐en‐Y reconstruction using either the da Vinci Xi (Xi group) or the da Vinci SP (SP group) system during our initial experience with the platform (SP group).
2.2. Surgical Procedures
All procedures were performed using robotic systems (da Vinci Xi or da Vinci SP). In the SP group, a hybrid approach termed MILAR was applied. In this approach, a single‐port access was created at the umbilicus, and two additional laparoscopic ports were inserted in the right abdomen for assistant use, allowing active participation of the laparoscopic operator [4]. The robotic operator used three instruments and a scope, while the laparoscopic assistant used two forceps through the right abdominal ports.
In contrast, in the Xi group, the procedure was performed using a conventional multi‐port robotic approach, with one assistant port placed in the right abdomen. The SP cohort consisted of the initial 11 cases following the introduction of the SP system at our institution. These procedures were performed by two surgeons certified by the Japan Society for Endoscopic Surgery. During the initial SP cases, the procedures were supported by experienced laparoscopic assistant surgeons who were also familiar with robotic gastrectomy using the da Vinci Xi system. In the Xi group, procedures were performed by non‐certified surgeons under the supervision of board‐certified expert surgeons.
2.3. Video Review and Time‐Structure Analysis
Operative videos were retrospectively reviewed by two investigators (T.H. and T.Y.) to analyze intraoperative time structure. Operative procedures were divided into five predefined surgical phases: (a) port placement phase (from insertion of the second port to completion of liver retraction), (b) No. 4sb lymphadenectomy phase (from initiation of omental division to completion of proximal greater curvature lymphadenectomy), (c) No. 4d/6 lymphadenectomy phase (from right‐sided omental division to completion of duodenal transection), (d) suprapancreatic lymphadenectomy phase (from initiation of peritoneal incision along the superior border of the pancreas to completion of lymphadenectomy around the celiac axis), and (e) no. 1/3 lymphadenectomy phase (from initiation of posterior lesser curvature dissection to completion of proximal lesser curvature lymphadenectomy). The operative time analyzed in this study was defined as the duration from skin incision to gastric transection. Two investigators independently reviewed each phase and measured effective time and junk time. When discrepancies of ≥ 1 min were identified between reviewers, the corresponding video segment was jointly re‐reviewed and the final measurement was determined by consensus. Among 200 analyzed surgical phases (40 cases × 5 phases), discrepancies requiring consensus review occurred in only 12 phases.
Operative time was further classified into effective time and junk time according to previously reported methods [3]. Effective time was defined as the time during which essential surgical procedures directly contributing to operative progress were performed, whereas junk time was defined as time not directly contributing to procedural progress, including robotic arm adjustment, instrument exchange, and other workflow interruptions not directly contributing to procedural progress. In addition, the number of camera cleaning events and robotic instrument exchanges was recorded for each case.
2.4. Statistical Analysis
Continuous variables were expressed as median (range or interquartile range) and compared using the Mann–Whitney U test. Categorical variables were compared using the chi‐square test or Fisher's exact test, as appropriate. The primary endpoints of this study were operative time (skin incision to gastric transection), effective time, and junk time. Secondary endpoints included the number of camera cleaning events and robotic instrument exchanges. A two‐sided p value < 0.05 was considered statistically significant. This retrospective study was approved by the Institutional Review Board of the National Cancer Center (approval number: 2017‐077) and was conducted in accordance with the ethical principles of the Declaration of Helsinki.
3. Results
3.1. Patient Characteristics
Patient characteristics and short‐term outcomes are summarized in Table 1. There were no significant differences between the SP and Xi groups in terms of age, sex, body mass index, tumor location, clinical stage, or extent of lymphadenectomy. The Xi group tended to include more advanced cases requiring D2 lymphadenectomy and preoperative chemotherapy; however, the difference was not statistically significant (p = 0.19). Intraoperative blood loss was significantly lower in the SP group compared with the Xi group (16 [6–27] vs. 25 [6–230] mL, p = 0.012). Postoperative complications (Clavien–Dindo ≥ Grade II) occurred in 2 patients (18.2%) in the SP group and 1 patient (3.4%) in the Xi group, with no significant difference between groups (p = 0.178). In the SP group, the complications included one case of pneumonia (Grade II) and one case of lower limb lymphorrhea (Grade IIIa). In the Xi group, one case of delayed gastric emptying (Grade II) was observed.
TABLE 1.
Patient's characteristics and short‐term outcomes.
| da Vinci SP (N = 11) | da Vinci Xi (N = 29) | p | |
|---|---|---|---|
| Age | 56 (42–68) | 62 (36–85) | 0.231 |
| Gender (male/female) | 5/6 | 14/15 | 1.000 |
| Body Mass Index (kg/m2) | 26.3 (16.1–32.5) | 21.8 (16.8–35.0) | 0.369 |
| Tumor location (U/M/L) | 5/5/1 | 11/15/3 | 0.878 |
| cStage (I/IIA/IIB/III/IV) | 10/0/1/0/0 | 24/0/2/2/1 | 1.000 |
| cT (1/2/3/4) | 9/1/0/1 | 20/4/1/4 | 1.00 |
| cN (0/+) | 11/0 | 26/3 | 0.548 |
| Preoperative chemotherapy (+/−) | 0/11 | 4/25 | 0.19 |
| Extent of lymphadenectomy (D1+/D2) | 9/2 | 21/8 | 0.696 |
| Intraoperative bleeding (mL) | 16 (6–27) | 25.0 (6–230) | 0.012 |
| Postoperative complications a | 2 (18.2%) | 1 (3.4%) | 0.178 |
Clavien–Dindo ≥ Grade 2.
3.2. Intraoperative Time Structure
The intraoperative time structure and related procedural factors are summarized in Table 2. Total operative time was significantly shorter in the SP group than in the Xi group (148.0 [118.0–211.0] vs. 204.0 [139.0–326.0] min, p = 0.001). Effective time was also significantly shorter in the SP group (111.2 [99.0–172.5] vs. 168.9 [106.2–242.5] min, p = 0.002). However, this finding should be interpreted cautiously because surgeon expertise and case complexity differed between groups. Junk time was significantly reduced in the SP group compared with the Xi group (30.4 [19.0–50.5] vs. 36.6 [19.3–110.7] min, p = 0.034). As shown in Figure 1, operative time in the Xi group demonstrated substantial variability, particularly in junk time, with several cases exhibiting markedly prolonged non‐productive time. In contrast, the SP group showed a more uniform distribution, with consistently reduced junk time across cases. Furthermore, in the Xi group, prolonged operative time was primarily associated with an increase in junk time rather than effective time, whereas in the SP group, both operative time and its variability were reduced, mainly associated with reduced junk time. Regarding procedural factors, the number of camera cleanings was comparable between the two groups (7 [4–12] vs. 7 [3–28], p = 0.502). In contrast, the number of robotic instrument exchanges was markedly lower in the SP group than in the Xi group (4 [2–9] vs. 46 [3–89], p < 0.001). These findings suggest that the reduction in junk time in the SP group is potentially associated with the marked decrease in robotic instrument exchanges.
TABLE 2.
Intraoperative time structure and workflow related procedural factors.
| da Vinci SP | da Vinci Xi | p | |
|---|---|---|---|
| Total time a (min) | 148.0 (118.0–211.0) | 204.0 (139.0–326.0) | 0.001 |
| Effective time (min) | 111.2 (99.0–172.5) | 168.9 (106.2–242.5) | 0.002 |
| Junk time (min) | 30.4 (19.0–50.5) | 36.6 (19.3–110.7) | 0.034 |
| Camera cleaning events (n) | 7 (4–12) | 7 (3–28) | 0.502 |
| Robotic instrument exchanges (n) | 4 (2–9) | 46 (3–89) | < 0.001 |
Total time was defined as the duration from skin incision to gastric transection following completion of lymphadenectomy.
FIGURE 1.
Comparison of intraoperative time structure between the Xi and SP groups. Comparison of intraoperative time structure between the Xi and SP groups. Each bar represents an individual case, with total operative time divided into effective time (blue) and junk time (red). Cases are arranged in descending order of total operative time within each group. The SP group demonstrates a consistent reduction in junk time compared with the Xi group, contributing to shorter total operative time. Effective time was also shorter in the SP group, although this finding should be interpreted with caution due to potential differences in case complexity.
3.3. Sensitivity Analysis According to Surgeon Certification Status
Exploratory sensitivity analyses were performed within the Xi cohort according to surgeon certification status (Table 3). Although limited by the small number of certificated cases, no substantial differences in effective time, junk time, camera cleaning events, or robotic instrument exchange frequency were observed between certificated and non‐certificated surgeons within the Xi group.
TABLE 3.
Exploratory sensitivity analysis of intraoperative time structure according to surgeon certification status within the Xi group.
| Non‐certified (n = 25) | Certified (n = 4) | p | |
|---|---|---|---|
| Total time a (min) | 201.0 (139.0–326.0) | 232.5 (205.0–301.0) | 0.077 |
| Effective time (min) | 157.0 (106.2–242.5) | 180.6 (169.0–218.9) | 0.181 |
| Junk time (min) | 36.0 (19.3–84.3) | 38.6 (34.1–110.7) | 0.253 |
| Camera cleaning events (n) | 7 (3–12) | 8 (6–10) | 0.750 |
| Robotic instrument exchanges (n) | 46 (3–89) | 37.5 (16–69) | 0.975 |
Total operative time was defined as the duration from skin incision to gastric transection, excluding the reconstruction phase.
4. Discussion
The present exploratory study evaluated intraoperative workflow during the initial clinical experience with the da Vinci SP system using the MILAR approach. Although the SP cohort represented the first consecutive cases at our institution, shorter total operative time accompanied by relatively reduced junk time was observed compared with the Xi group, whereas effective time was also shorter. These findings should be interpreted with caution because the observed differences may have reflected the combined influence of several potential confounding factors, including differences in surgeon experience, the experience of the laparoscopic assistant, workflow familiarity, surgical approach, robotic platform, and case complexity. Specifically, the SP cohort consisted of initial cases performed by certified surgeons, whereas more advanced cases—including those requiring D2 lymphadenectomy or preoperative chemotherapy—tended to be included in the Xi group. These differences in surgeon experience and case complexity may have contributed to the observed reduction in effective time. To further explore the potential influence of surgeon experience, exploratory sensitivity analyses were performed within the Xi cohort. No substantial differences in effective time, junk time, or robotic instrument exchange frequency were observed according to surgeon certification status, although interpretation remains limited by the small sample size. While these exploratory analyses cannot eliminate residual confounding, they suggest that surgeon certification alone is unlikely to fully explain the observed differences in intraoperative time structure. Previous reports have suggested that the MILAR approach provides stable surgical exposure through coordinated use of robotic and laparoscopic instruments [4, 5]. These workflow characteristics may also have contributed to the observed differences. However, because the present findings were likely influenced by multiple interacting factors, the contribution of the MILAR workflow cannot be evaluated independently. Accordingly, the observed workflow characteristics should not be attributed to the SP platform or the MILAR approach alone. Instead, the present findings should be interpreted as describing workflow characteristics observed during the initial clinical experience with the SP platform.
The most notable finding of this study is that the reduction in junk time in the SP group appears to be associated with a marked decrease in robotic instrument exchanges. The concept of junk time, defined as non‐productive intraoperative time that does not directly contribute to surgical progress, has been previously proposed in the analysis of surgical workflow [3]. Prior studies have suggested that robotic surgery is associated with longer junk time compared with laparoscopic surgery, mainly due to frequent instrument exchanges, robotic arm adjustments, and workflow interruptions [3]. In the MILAR approach, several operative tasks, including vessel sealing and clipping, are intentionally performed by the laparoscopic assistant through additional ports [4, 5]. Consequently, the reduced frequency of robotic instrument exchanges observed in the present study may partly reflect redistribution of operative tasks within the surgical team rather than improved robotic efficiency itself. At the same time, this redistribution may reduce opportunities to utilize the unique capabilities of the robotic platform, such as articulated instruments, tremor filtration, motion scaling, and three‐dimensional visualization, during those operative steps. From this perspective, the observed reduction in robotic instrument exchanges should not be interpreted as evidence of superior robotic performance. Rather, it reflects a different organization of operative tasks within the surgical team. Such task sharing may reduce interruptions associated with robotic instrument exchange and contribute to reduced non‐productive intraoperative time. Whether this balance between workflow efficiency and utilization of robotic functionality translates into improved clinical outcomes remains to be determined. Accordingly, the present findings are best interpreted as describing workflow characteristics of a hybrid team‐based approach rather than improved robotic efficiency.
Previous studies on gastric cancer surgery using the da Vinci SP system have generally shown that this approach is feasible and safe, with low blood loss, acceptable operative times, and no clear increase in major complications [6, 7, 8]. A prospective phase I/II trial reported no major postoperative complications and early recovery, while retrospective studies demonstrated minimal blood loss and acceptable morbidity with standard lymphadenectomy [6, 7]. From the perspective of reduced invasiveness, true single‐port surgery may offer advantages in cosmetic outcomes, postoperative pain, and quality of life. A meta‐analysis comparing single‐port and multiport laparoscopic gastrectomy showed less blood loss, reduced analgesic use, and shorter hospital stay in the single‐port group, without an increase in complications [8]. In addition, recent multicenter data demonstrated faster postoperative recovery without increased complications, although operative time was longer with SP approaches [9]. The present findings should not be interpreted as indicating that MILAR represents the definitive surgical strategy for robotic gastrectomy using the SP platform. Rather, MILAR may be regarded as one practical strategy during the early clinical use of the SP platform. In the present series, the initial SP procedures were performed with the participation of highly experienced laparoscopic assistant surgeons who were familiar with both advanced laparoscopic and robotic gastrectomy. Such collaboration may provide intraoperative guidance, promote efficient task sharing, and support team‐based acquisition of procedural skills during the introduction of a new robotic platform. However, this reliance on experienced assistants may limit the generalizability of the present workflow to institutions with different levels of surgical team experience. As robotic technology continues to evolve, with further improvements in instrumentation and workflow integration, the need for hybrid task sharing may decrease. Nevertheless, the concept of team‐based workflow optimization may remain valuable during the introduction of new robotic platforms and may also represent a practical option when extending robotic surgery to more technically demanding procedures. Although MILAR requires additional assistant ports and may be inferior to pure single‐port surgery in terms of cosmetic outcomes, it still reduces the number of ports compared with conventional robotic surgery and may retain some advantages of reduced‐port surgery. Importantly, the present findings do not suggest an increase in complications related to robotic surgical techniques, such as pancreatic fistula or anastomotic leakage. Although the overall complication rate was higher in the SP group, these events were not procedure‐related.
The concept of junk time provides a useful framework for understanding operative efficiency beyond total operative time alone [3]. Quantifying non‐productive intraoperative processes may help identify modifiable factors contributing to prolonged procedures and offer a rational strategy for optimizing surgical workflow.
This study has several limitations. First, this was a retrospective exploratory study conducted at a single institution, which may introduce inherent selection bias. Second, the sample size was relatively small, particularly in the SP cohort. Third, the SP cohort represents the initial experience with the system, and the learning curve for the MILAR approach may not have been fully stabilized. The current study cannot determine the extent to which further procedural refinement may influence intraoperative workflow. Nevertheless, continued technical standardization and increasing familiarity with the SP platform may further streamline intraoperative workflow in future practice. Fourth, multiple factors differed simultaneously between the SP and Xi groups, including the robotic platform, surgical approach, surgeon experience, the experience of the laparoscopic assistant, and case complexity. Therefore, the observed differences cannot be attributed specifically to either the SP platform or the MILAR approach. Although exploratory sensitivity analyses were performed within the Xi cohort, they could not fully resolve this limitation. Fifth, the present workflow was developed during the initial clinical experience with the SP platform using highly experienced laparoscopic assistant surgeons. Accordingly, the findings may not be readily generalizable to institutions with different levels of surgical team experience. Furthermore, the present analysis did not include the reconstruction phase; therefore, the impact of the MILAR workflow on the entire operative procedure remains unclear. Reconstruction procedures were excluded because reconstruction methods and the extent of extra‐abdominal procedure varied depending on obesity, abdominal cavity conditions, and remnant stomach size, which may have reduced comparability between cases. Finally, although junk time analysis may provide insight into intraoperative workflow, the clinical relevance and broader applicability of this analytical approach remain to be established. In addition, the high cost of the da Vinci SP system may limit its widespread adoption.
In conclusion, the present exploratory study describes differences in intraoperative time structure observed during the initial clinical experience with the MILAR approach using the da Vinci SP system. These findings provide insight into workflow characteristics of a hybrid team‐based approach and may serve as a foundation for future studies evaluating workflow optimization and the evolving role of MILAR in robotic gastrectomy.
Funding
The authors have nothing to report.
Ethics Statement
This study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of the National Cancer Center (approval number: 2017‐077).
Conflicts of Interest
Yusuke Kinugasa received personal fees (speaker honoraria) from Intuitive Surgical G.K. outside the submitted work. The other authors declare no conflicts of interest.
Acknowledgments
The authors thank all medical staff involved in patient care and data collection.
Data Availability Statement
Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.
References
- 1. Guerrini G. P., Esposito G., Paolo M., et al., “Robotic Versus Laparoscopic Gastrectomy for Gastric Cancer: The Largest Meta‐Analysis,” International Journal of Surgery 82 (2020): 210–228. [DOI] [PubMed] [Google Scholar]
- 2. Du R., Wan Y., Shang Y., and Lu G., “Robotic Versus Laparoscopic Gastrectomy for Gastric Cancer: The Largest Systematic Reviews of 68,755 Patients and Meta‐Analysis,” Annals of Surgical Oncology 32 (2024): 351–373, 10.1245/s10434-024-16371-w. [DOI] [PubMed] [Google Scholar]
- 3. Liu H., Kinoshita T., Tonouchi A., Kaito A., and Tokunaga M., “What Are the Reasons for a Longer Operation Time in Robotic Gastrectomy Than in Laparoscopic Gastrectomy for Stomach Cancer?,” Surgical Endoscopy 33 (2019): 192–198. [DOI] [PubMed] [Google Scholar]
- 4. Yoshikawa T., Hayashi T., Nishino M., et al., “A New Hybrid Robotic Surgery by Minimally Invasive Laparoscopic and Robotic (MILAR) System Using da Vinci Single‐Port (SP) in Distal Gastrectomy for Gastric Cancer,” Asian Journal of Endoscopic Surgery 18 (2025): e13401. [DOI] [PubMed] [Google Scholar]
- 5. Yoshikawa T., Hayashi T., Nishino M., et al., “Short‐Term Outcomes of a Novel Hybrid Technique, Minimally Invasive Laparoscopic and Robotic Surgery (MILAR) Using the da Vinci SP System for Gastric Cancer,” Asian Journal of Endoscopic Surgery 18 (2025): e70012. [DOI] [PubMed] [Google Scholar]
- 6. Park S. H., Kim Y. N., Hwang J., et al., “Safety and Feasibility of Reduced‐Port Robotic Distal Gastrectomy for Gastric Cancer: A Phase I/II Clinical Trial Using the da Vinci Single Port (SP) Robotic System,” Scientific Reports 13 (2023): 18578. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7. Ito A., Nakauchi M., Fujita M., et al., “Initial Clinical Experiences of Robotic Distal Gastrectomy for Gastric Cancer Using the Da Vinci SP System: A Single‐Center Retrospective Study,” Langenbeck's Archives of Surgery 410 (2025): 110. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. Zhu G., Lang X., Zhou S., et al., “Short‐ and Long‐Term Outcomes of Single‐Port Versus Multiport Laparoscopic Radical Gastrectomy for Gastric Cancer: A Meta‐Analysis of Propensity Score‐Matched Studies and Randomized Controlled Trials,” BMC Surgery 23 (2023): 223. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9. Chung J. H., Kim H. I., Ahn S. H., et al., “Balancing Surgical Innovation With Indications: A Multicenter Retrospective Comparison of Reduced‐Port Distal Gastrectomy Using da Vinci SP Versus Multi‐Port Robotic Platforms From the KLASS‐13 Cohort,” Cancers 18 (2026): 823. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.