Exploratory Analysis of Intraoperative Time Structure During the Initial Clinical Experience With Minimally Invasive Laparoscopic and Robotic Surgery (MILAR) Using the da Vinci SP System.

BACKGROUND

Robotic gastrectomy has been adopted for gastric cancer. However, operative time remains longer than that of laparoscopic surgery. Junk time has been proposed as a major contributor to prolonged operative duration. This study evaluated intraoperative time structure during the initial clinical experience with the minimally invasive laparoscopic and robotic (MILAR) approach using the da Vinci SP system.

METHODS

This retrospective exploratory workflow analysis included consecutive patients who underwent robot-assisted distal gastrectomy with D1+/D2 lymphadenectomy between May 2024 and June 2025. Patients were divided into the SP (MILAR) group and the conventional multi-port robotic (Xi) group. Operative videos from skin incision to gastric transection were reviewed to quantify effective time and junk time.

RESULTS

A total of 40 patients were analyzed (SP, n = 11; Xi, n = 29). Total operative time was significantly shorter in the SP group than in the Xi group (148.0 vs. 204.0 min, p = 0.001). Junk time was significantly reduced (30.4 vs. 36.6 min, p = 0.034), accompanied by fewer robotic instrument exchanges (4 vs. 46, p < 0.001). Effective time was shorter in the SP group; although this finding may have been influenced by surgeon expertise and case complexity. No increase in procedure-related complications was observed in the SP group.

CONCLUSIONS

The present exploratory study describes differences in intraoperative time structure observed during the initial clinical experience with the MILAR approach using SP system. These findings provide insight into workflow characteristics of a hybrid team-based approach and warrant further evaluation in prospective studies.