Robotic single-port versus multi-port distal gastrectomy for gastric cancer: a comparative analysis of the da Vinci™ SP and Xi systems

Background: Single-port surgery offers improved cosmesis but is technically demanding. The da Vinci™ SP (DVSP) system aims to overcome these challenges; however, rigorous data on the comparison between the DVSP system and the standard multi-port da Vinci™ Xi system (DVXi) are scarce. This study aimed to compare the short-term outcomes of the DVSP with those of the DVXi for robotic distal gastrectomy after adjusting for patient selection bias. Methods: We retrospectively reviewed 311 patients undergoing robotic distal gastrectomy for gastric cancer between March 2023 and December 2024 at two institutions. Based on patient demographics and tumor characteristics, a 1:1 propensity score matching analysis was performed to mitigate bias. After matching, 36 patients in the DVSP group were compared with 36 patients in the DVXi group. Perioperative outcomes, pathological findings, and postoperative complications were analyzed. Results: The DVSP group had significantly shorter median operative time (329 vs. 414 min, p < 0.001) and console time (261 vs. 332 min, p < 0.001). A significantly higher number of lymph nodes were retrieved in the DVSP group (mean 46 vs. 32, p = 0.04). The median postoperative stay exhibited a trend toward being shorter in the DVSP group (11 vs. 12 days, p = 0.08). No conversions to open or multi-port surgery occurred. The incidence of postoperative complications (Clavien–Dindo grade ≥ II) was comparable between the groups (8.3% vs. 16.7%, p = 0.48). Conclusions: In this study, single-port gastrectomy using the DVSP system was safe and feasible in the short-term outcomes compared with multi-port gastrectomy using the DVXi system.