First Annual Report for Robot-Assisted Surgery Based on the National Clinical Database 2019 in Japan: Report on Three Major Gastrointestinal Fields

Aim: The adoption of robot-assisted surgery (RAS) in Japan has progressed significantly since its initial approval in 2009. RAS gradually expanded into various surgical fields with 35 procedures now covered under Japan's national health insurance. This study provides an inaugural assessment of RAS outcomes for seven digestive procedures introduced in 2018. Methods: The Japanese Society for Endoscopic Surgery working group established an RAS registry integrating data from the National Clinical Database and additional RAS-specific records. The analysis focused on three major gastrointestinal fields: the esophagus, stomach, and rectum. Results: In 2019, 530 esophagectomies, 2295 gastrectomies, and 3269 proctectomies were performed. RAS for these procedures was characterized by relatively long operative times, low intraoperative blood loss, and very low conversion rates to open surgery (< 1%). Postoperative morbidity rates Grade IIIa or higher were 23.2% for esophagectomy, 4.9% for gastrectomy, and 9.4% for proctectomy. Length of postoperative hospital stay correlated with morbidity, though readmission (1.3%–3.1%) and postoperative mortality rates (0.3%–0.6%) remained low. The early nationwide implementation of RAS in Japan was marked by a high surgeon qualification rate (98.9%) and meticulous case selection; the DVSS Xi model accounted for 66.3% of robotic platforms used. Conclusion: These findings underscore the need for ongoing surveillance and data-driven evaluation to ensure safe and effective implementation of RAS. Future longitudinal analyses will refine surgical quality, optimize resource allocation, and advance minimally invasive techniques. This study highlights the transformative potential of RAS in Japanese surgical practice and its alignment with global trends.