Precision and Progress: Evaluating the Role of Robotic Surgery Gastric Cancer Treatment – A Comprehensive Review by TROGSS – The Robotic Global Surgical Society & EFISDS - European Federation International Society for Digestive Surgery Joint Working Group

Introduction: Robotic-assisted minimally invasive gastrectomy (RAMIG) rep- resents a significant advancement in the surgical management of gastric cancer, offering superior dexterity, enhanced visualization, and improved ergonomics compared to lapa- roscopic gastrectomy (LG). This review systematically evaluates the current evidence on perioperative outcomes, oncological efficacy, learning curves, and economic considera- tions, providing insights into RAMIG’s potential role in modern gastric cancer surgery. Methods: A thorough analysis of retrospective, prospective, and meta-analytic studies was conducted to compare RAMIG with LG. Key outcomes, including operative time, in- traoperative blood loss, lymph node retrieval, postoperative complications, learning curve duration, and cost-effectiveness, were assessed. Emphasis was placed on both short- term and long-term oncological outcomes to determine the clinical value of RAMIG. Re- sults: Evidence indicates that RAMIG is associated with reduced intraoperative blood loss, lower morbidity rates, and a shorter learning curve, with proficiency achieved after 11–25 cases compared to 40–60 cases for LG. The robotic platform’s articulated instru- ments and enhanced three-dimensional visualization enable more precise lymphadenec- tomy, particularly in complex anatomical regions. Despite these advantages, operative time remains longer, and costs remain higher due to system acquisition, maintenance, and consumable expenses. However, emerging data suggest a gradual narrowing of cost dis- parities. While short-term outcomes are favorable, further high-quality, multicenter stud- ies are needed to validate long-term oncological efficacy and survival outcomes. Conclu- sion: RAMIG offers significant technical and clinical advantages over conventional LG, particularly in terms of precision and learning efficiency. However, the long-term onco- logical benefits and economic feasibility require further validation. Future research should focus on cost optimization, advanced technological integration such as near-infrared flu- orescence and artificial intelligence, and multicenter trials to solidify RAMIG’s role as a standard approach for gastric cancer surgery.