Objective To investigate the clinical value of domestic robotic-assisted single-port plus one radical distal gastrectomy.

Methods The retrospective and descriptive study was conducted. The clinicopathological data of 25 patients who underwent domestic robotic‑assisted single‑port plus one radical distal gastrectomy at the First Affiliated Hospital of Wenzhou Medical University from August 2024 to August 2025 were collected. There were 19 males and 6 females, aged 65(range, 29-78)years. Observation indicators: (1) surgical conditions; (2) postoperative conditions; (3) CUSUM learning curve analysis; (4) follow‑up. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test.

Results (1) Surgical conditions. All 25 patients underwent domestic robotic-assisted single-port plus one radical distal gastrectomy successfully, with no conversion to open surgery or laparoscopic surgery. The robotic setup time was (32±5)minutes, time from inserting robotic instruments to closing the abdominal cavity was (295±60)minutes. The single‑port incision length of 25 patients was 3.1(range, 2.7-3.4)cm. All 25 patients underwent radical distal gastrectomy with D₂ lymph node dissection, with the number of lymph node dissected as 27(range, 21-64). Of 25 patients, 15 patients underwent Roux‑en‑Y anastomosis, and 10 patients underwent Billroth Ⅱ anastomosis. The volume of intraoperative blood loss of 25 patients was 20(range, 10-100)mL, and no blood transfusion was performed. (2) Postoperative conditions. The time to postoperative first flatus of 25 patients was (2.5±0.7)days, time to postoperative first defecation was (4.5±2.1)days, time to postoperative first liquid diet intake was (3.4±1.1)days, and time to postoperative first ambulation ≥5 minutes was (3.0±1.3)days. Four patients developed postoperative complications of ≥grade Ⅱ Clavien‑Dindo classification , including 3 cases of grade Ⅱ and 1 case of grade Ⅲb. The incidence of major perioperative complications was 16%(4/25). Duration of postoperative hospital stay of 25 patients was (7.6±1.6)days, and the hospitalization cost was (53 964±11 543)yuan. Results of postoperative pathological examination showed 1 case of undifferentiated carcinoma, 12 cases of poorly differentiated carcinoma, 12 cases of moderate‑well differentiated carcinoma, tumor diameter of 25 patients as 2.0(range, 0.3-5.0)cm, 16 cases of TNM stage Ⅰ, 5 cases of TNM stage Ⅱ, 4 cases of TNM stage Ⅲ, none of patient with tumor distant metastasis and all tumor margins as negative. (3) CUSUM learning curve analysis. Results of CUSUM learning curve combined with segmented regression model showed operation time, volume of intraoperative blood loss, the number of intraoperative lymph node dissected and duration of postoperative hospital stay entered the stable stage after the 11th, 17th, 18th and 16th cases, respectively. There were significant differences in operation time and the number of intraoperative lymph node dissected between the learning stage and stable stage (t=3.57, U=23.00, P<0.05), and there was no significant difference in volume of intraoperative blood loss or duration of postoperative hospital stay between the learning stage and stable stage (U=101.50, t=1.38, P>0.05). (4) Follow‑up. All 25 patients were followed up for 6 (range, 1-12)months. During the follow‑up period, one patient was readmitted due to intes-tinal obstruction and improved after surgical treatment, while the remaining 24 patients did not experience significant discomfort such as abdominal pain or bloating. All 25 patients had no local tumor recurrence or distant metastasis, and no postoperative complications such as delayed bleeding, anastomotic leakage, or anastomotic stenosis occurred.

Conclusion Clinical application of domestic robotic-assisted single‑port plus one radical distal gastrectomy is safe and feasible.