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.

[INTRODUCTION] The da Vinci SP (SP) has only 1 robotic arm, containing 4 channels. It provides a wide space for assistant surgeons using laparoscopic forceps. We performed a new type of minimally invasive surgery using laparoscopy and a robot (MILAR) utilizing the SP in distal gastrectomy for gastric cancer.

[MATERIALS AND SURGICAL TECHNIQUE] An incision at the umbilicus was made for the SP, and 2 ports were inserted from the right abdomen for laparoscopic surgery. In the above view, where surgeons look down at the surgical field, the scope was inserted from the channel at 12 o'clock, and the round tooth retractor was inserted from 6 o'clock. In the below view, where surgeons look up at the surgical field, the scope and retractor were inserted from opposite directions. The robotic operator uses 3 forceps and a scope. The laparoscopic operator uses 2 forceps. On the greater curvature side, the left or right epiploic artery pedicles was retracted by the robot operator under the below view. The suprapancreatic area was dissected with the pedicle of the left gastric artery retracted by the laparoscopic operator under the above view.

[DISCUSSION] By setting the scope and the retractor in a diagonal direction of 12-6 o'clock, robotic surgeons have a wide space bilaterally for using forceps for nodal dissection under the co-axial setting. Laparoscopic surgeons can use this space easily. Gastrectomy by MILAR using SP could provide quality surgery within a short operative time.