In the era of minimally invasive surgery, single-port (SP) robotic surgery has garnered significant attention for its advantages such as flexible maneuverability and reduced trauma. In July 2023, the team of Professor Li Leping and Professor Liang Shang at Shandong Provincial Hospital Affiliated to Shandong First Medical University successfully completed the world's first (and second) pure single-port robotic radical total gastrectomy (SPRTG) using the domestically produced Shurui® SR-ENS-600 single-port robotic system. This study, authored by Liang Shang, Li Leping, and team members from the hospital's Department of Gastrointestinal Surgery, was published in the Chinese Medical Journal.

This research broke through the application limitations of single-port robotic surgery in the field of radical treatment for advanced gastric cancer, for the first time confirming the safety, feasibility, and efficacy of pure single-port robotic technology in this procedure, thereby filling a gap in the global literature. Based on the surgical practice and long-term follow-up of two patients with advanced gastric cancer, the study provides new ideas for minimally invasive surgery in gastrointestinal surgery and lays an important foundation for the clinical expansion of domestically produced single-port surgical robots.

The article, titled "The world's first pure single-port robotic radical total gastrectomy for advanced gastric cancer," was published in the *Chinese Medical Journal*, a core journal with international influence in China's medical field, providing an important academic exchange platform for medical researchers worldwide.

Research Background

With the continuous iteration of minimally invasive surgical techniques, single-port robots are increasingly widely used in surgery. In 2009, Kaouk et al. first applied the SP robotic surgical system to radical prostatectomy and radical nephrectomy, confirming its clinical safety. Subsequently, single-port robotic surgery gradually expanded into the gastrointestinal field. Dreifuss et al. reported its application in partial gastrectomy for gastrointestinal stromal tumors, Cui et al. completed single-port robotic total gastrectomy for advanced gastric cancer using extracorporeal anastomosis, and Park et al. confirmed its safety in reduced-port distal gastrectomy for gastric cancer. However, none of these studies achieved pure single-port robotic application in radical surgery for advanced gastric cancer independently.

The Chinese Expert Consensus on Robotic Gastric Cancer Surgery* (2021 edition) only limited the indications for robotic surgery to patients with tumor invasion depth ≤ T4a and preoperative stage I or II. Minimally invasive radical treatment for advanced gastric cancer still faces technical bottlenecks. Against this backdrop, the Gastrointestinal Surgery team at Shandong Provincial Hospital Affiliated to Shandong First Medical University conducted relevant research, utilizing the domestically produced Shurui SR-ENS-600 SP robotic system to complete the world's first pure single-port robot-assisted radical total gastrectomy for advanced gastric cancer, filling a gap in the field.

Clinical Outcomes

1. First Case Successfully Performed:

In July 2023, the team completed the world's first pure SP robotic radical total gastrectomy for advanced gastric cancer. The patient was a 49-year-old male with cardia cancer involving the lesser curvature of the gastric body, preoperative stage cT3N2M0 (AJCC 8th edition). On the same day, a second patient, a 61-year-old female with locally advanced gastric cancer, also successfully underwent SPRTG.

2. Extreme Minimally Invasiveness:

All procedures (including D2 dissection and intracorporeal anastomosis) were completed through a single 3 cm incision around the umbilicus. Intraoperative blood loss was only 10 mL.

3. Surgical Efficiency and Precision:

Total gastrectomy + D2 lymphadenectomy + intracorporeal esophagojejunostomy + Braun anastomosis were successfully completed within 4 hours. Only the robot's coagulation function was used throughout the procedure, without additional energy devices such as an ultrasonic scalpel.

4. Thorough Lymph Node Dissection:

Over 60 lymph nodes were harvested in both patients, meeting the requirements for radical cure.

5. Excellent Short-term and Long-term Outcomes:

No short-term postoperative complications or deaths were reported. With follow-up exceeding one year, both patients had no significant discomfort and no evidence of tumor recurrence.

Significance of the Study

1. Breaking Through Indication Barriers:

Successfully extended the indications for single-port robotic surgery from early gastric cancer or simple gastrectomy to advanced gastric cancer requiring complex lymph node dissection and intracorporeal digestive tract reconstruction (invasion depth ≤ T4a, stage III).

2. Validating Domestic Equipment Capability:

Fully demonstrated the safety, feasibility, and precision of the Shurui SR-ENS-600 system in highly difficult radical surgery for gastrointestinal tumors.

3. Providing a Technical Paradigm:

Offers a complete technical process and safety evidence for subsequent single-port robotic radical gastrectomy procedures.

Original Text Highlights

1. Precise Implementation of Snake-Arm Pure Single-Port Surgery:

"The surgery was completed through a single abdominal incision. A 3 cm incision was made around the umbilicus to establish the port access, and snake-arm robotic manipulators were used for retraction to fully expose the perigastric tissues. Total gastrectomy and D2 lymphadenectomy were successfully completed within 4 hours, followed by intracorporeal esophagojejunostomy and Braun anastomosis."

2. Core Data on Surgical Safety and Efficacy:

"The surgical procedure was smooth, with intraoperative blood loss of only 10 mL. Only the coagulation function of the robotic surgical system was used throughout the surgery, without additional energy devices such as an ultrasonic scalpel. No short-term postoperative complications or deaths were reported."

"To date, both patients have been followed up for more than one year, neither has developed significant discomfort symptoms, and no tumor recurrence has been observed."

3. Discussion of Surgical Advantages and Indication Expansion:

"Compared with traditional robotic surgery and laparoscopic surgery, SP robotic surgery offers significant advantages: surgical precision is enhanced due to the flexibility of robotic manipulation; furthermore, fewer and smaller incisions are required, achieving minimal trauma, nearly invisible scars, no 'chopstick effect,' and faster recovery."

"The application of SP robotic surgery to patients with advanced gastric cancer represents an extension and deepening of our center's existing indications."

Innovation and Breakthrough

This study broke the traditional notion that "single-port robots are not suitable for complex radical gastric cancer surgery," providing the first evidence of feasibility and safety for pure single-port radical surgery in locally advanced gastric cancer (cT3N2M0, stage III). It surpasses similar international reports (Cui et al. required a 7 cm incision for extracorporeal anastomosis; Park et al. only performed reduced-port distal gastrectomy), truly achieving "pure single-port total gastrectomy + intracorporeal anastomosis."

In terms of surgical innovation: A single 3 cm peri-umbilical hidden incision achieves the unity of radical cure and aesthetics. D2 dissection, total gastrectomy, intracorporeal esophagojejunostomy, and Braun anastomosis were successfully integrated on a single-port platform. Indications were extended from consensus-recommended stage I-II to stage III, deepening and expanding existing consensus.

Conclusion

The successful completion of the world's first pure single-port robot-assisted radical total gastrectomy for advanced gastric cancer not only marks a new stage for single-port robotic surgery, advancing from early gastric cancer and simple gastrectomy to complex D2 radical resection and intracorporeal anastomosis, but also proves the clinical value of the domestically produced Shurui SR-ENS-600 system in the most difficult gastrointestinal tumor surgeries. With excellent outcomes of a single 3 cm incision, 10 mL blood loss, and 1-year recurrence-free survival, this study responded to traditional doubts that "single-port robots are not suitable for radical treatment of advanced gastric cancer," providing patients with locally advanced gastric cancer a minimally invasive option featuring less trauma, faster recovery, and better cosmesis. As evidence-based medical evidence accumulates and domestic equipment continues to optimize, pure single-port robotic surgery is expected to become an important direction for the surgical treatment of gastric cancer, achieving the dual goals of tumor radical cure while maximizing rapid recovery and quality of life for patients, propelling China's minimally invasive gastric cancer surgery to a higher level.