Robotic Total Gastrectomy: Key Operative Maneuvers and Optimal Use of the Fourth Arm

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Key Points

The aim is to describe the effective use of the fourth robotic arm during total gastrectomy procedures to enhance surgical outcomes.
Presented a video of robotic total gastrectomy for gastric adenocarcinoma.
Optimized port placement for engaging the fourth arm.
Used indocyanine green to confirm esophageal transection level.
Performed D2 lymphadenectomy with the fourth arm assisting.
Completed reconstruction with a retrocolic Roux limb and hand-sewn anastomoses.
Fourth arm provided consistent counter-traction and improved vascular visualization.
Achieved precise, tension-controlled suturing during reconstruction.
Operative time recorded at 5 hours and 17 minutes with minimal blood loss.
Pathology confirmed poorly differentiated gastric adenocarcinoma with adequate lymph node harvest.
Patient discharged on postoperative day 4 without complications.

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Video presentation reveals improved precision in gastric surgery using the fourth arm in robotic total gastrectomy, suggesting enhanced outcomes.

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Hierl et al. (2026) studied this question.

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