ArticleSurgical oncology insight2026
Robotic total gastrectomy: Key operative maneuvers and optimal use of the fourth arm.
Article in Surgical oncology insight, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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4 authors.
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Abstract
Background: The robotic platform offers distinct advantages for total gastrectomy, particularly through effective use of the fourth robotic arm. Methods: We present a video of robotic total gastrectomy performed for a patient with gastric adenocarcinoma. Key technical elements include port placement optimized for fourth-arm engagement (Fig. 1) Results: The fourth arm provided consistent counter-traction during lymphadenectomy, improved visualization of critical vascular anatomy, and enabled precise, tension-controlled suturing during esophagojejunostomy and jejunojejunostomy. Operative time was 5 h and 17 min with estimated blood loss < 100 mL. Final pathology demonstrated pT4aN3a poorly differentiated gastric adenocarcinoma with adequate lymph node harvest. The patient recovered uneventfully and was discharged on postoperative day 4. Conclusion: Thoughtful, dynamic use of the fourth robotic arm enhances exposure, ergonomics, and precision during robotic total gastrectomy. Mastery of fourth-arm techniques is critical for safe D2 lymphadenectomy, tension-free reconstruction, and reproducible outcomes in complex gastric surgery.
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