A comparative study of the ‘3 + 2’ model ‘seven-step method’ programmed robotic distal gastric cancer radical resection versus conventional robotic surgical techniques

This study aimed to compare perioperative outcomes, costs, and learning-curve characteristics between a “3 + 2” model combined (The operation is performed by three robotic arms, with two assistants providing assistance). with a “seven-step” standardized robotic surgical procedure and conventional robotic surgery for radical distal gastrectomy in distal gastric cancer, and to evaluate its clinical applicability. A retrospective cohort study was conducted. A total of 215 patients who underwent robot-assisted radical distal gastrectomy at Gansu Provincial People’s Hospital between May 2018 and October 2023 were included. According to the actual surgical approach used, patients were assigned to either the “3 + 2” model “seven-step” group (n = 107) or the conventional robotic group (n = 108). Perioperative indices, postoperative complications, and surgical costs were compared between the two groups. The learning curve was analyzed using cumulative sum (CUSUM) analysis based on operative time. Robot-assisted surgery was successfully completed in both groups, with no conversion to open surgery and no perioperative mortality. Compared with the conventional group, the “3 + 2” model “seven-step” group had a shorter operative time (P < 0.05). CUSUM analysis showed that the inflection point occurred at case 16 in the “3 + 2” group and at case 19 in the conventional group, indicating that the “3 + 2” group reached a relatively stable operative-time phase earlier. There were no statistically significant differences between the groups in intraoperative blood loss, postoperative complication rate, or postoperative length of stay (P > 0.05). No statistically significant difference in total surgical costs was observed between the two groups. The “3 + 2” model “seven-step” standardized robotic radical distal gastrectomy for distal gastric cancer demonstrated perioperative safety comparable to that of conventional robotic surgery, while reducing operative time and achieving an earlier transition to a relatively stable phase on the learning curve. Cost differences should be further evaluated in larger samples and with more detailed cost-item analyses.