A case of robotic-assisted distal gastrectomy and cholecystectomy for gastric cancer and cholelithiasis in a patient with severe kyphosis.

Severe kyphosis presents significant anatomical challenges in laparoscopic surgery, including a restricted operative field and limited instrument mobility. We report an 85-year-old woman with marked thoracolumbar kyphosis who underwent successful robotic-assisted distal gastrectomy and cholecystectomy for gastric cancer and cholelithiasis. Preoperative three-dimensional CT simulation was used to plan port placement. Because of the low-lying costal arches, conventional laparoscopic methods were unsuitable. The da Vinci Xi surgical system enabled effective elevation of the costal margin and liver using robotic arms and a soft silicone disc, securing a sufficient operative field. Despite anatomical difficulties, the procedures were completed safely with minimal blood loss. Pathological findings revealed pT4aN3bM0 pStage ⅢC disease. The patient was discharged without major complications. This case highlights how robotic-assisted surgery can overcome anatomical barriers and be a viable option in patients with spinal deformities.