***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Minimally invasive surgery ( MIS ) has emerged as a treatment of choice for early-stage gastric cancer . However , applying MIS to gastric patients with high body mass index ( BMI ) is technically challenging , especially when performing D2 lymphadenectomy . Recently , robotic systems have been adopted to overcome the technical limitations of conventional laparoscopic surgery . Nevertheless , studies on the impact of the use of robotic systems to perform D2 lymphadenectomy in high BMI patients are lacking . Accordingly , this study was design ed to compare the quality of lymphadenectomy , together with surgical outcomes , by robotic distal subtotal gastrectomy with D2 lymphadenectomy ( RDGD2 ) to those by laparoscopic distal subtotal gastrectomy with D2 lymphadenectomy ( LDGD2 ) in patients of different BMI status . Methods Retrospective review of a prospect ively collected data base identified 400 gastric cancer patients who underwent either RDGD2 ( n = 133 ) or LDGD2 ( n = 267 ) between 2003 and 2010 . Patients were categorized according to surgical approach and BMI . We compared clinicopathologic characteristics , as well as short-term and long-term outcomes , between surgery and BMI groups . Results Regardless of BMI , RDGD2 required significantly longer operation time than LDGD2 ( p = 0.001 ) ; meanwhile , RDGD2 showed significantly less blood loss than LDGD2 ( p = 0.005 ) . Between BMI groups , RDGD2 showed no significant difference in the rate of retrieving more than 25 lymph nodes ( p = 0.181 ) ; however , LDGD2 was associated with a significantly lower rate of retrieving more than 25 lymph nodes in high BMI patients ( p = 0.006 ) . In high BMI patients , complications did not significantly differ between surgical approaches . As well , RDGD2 and LDGD2 demonstrated no statistically significant survival difference according to BMI status . Conclusions The benefits of a robotic approach were more evident in high BMI patients than in normal BMI patients when performing distal subtotal gastrectomy with D2 lymphadenectomy , particularly in terms of blood loss and consistent quality of lymphadenectomy .  Robotic surgery could be an effective alternative to conventional laparoscopic surgery in treating gastric cancer patients with high BMI Objective : To evaluate the technical feasibility , effectiveness , and safety of  robot-assisted gastrectomy ( RAG ) with lymphadenectomy , using the da Vinci system through analyses of our initial series of 100 consecutive patients . Summary Background Data : The application of robotic surgery was proven to be one of the best cutting-edge technologies for successful minimally invasive surgery by providing solutions to the many drawbacks of laparoscopic surgery , yet few reports have studied robotic surgery in gastric cancer . Methods : A review of a prospect ively design ed data base at our institute from July 2005 to October 2007 revealed a series of 100 consecutive RAG patients with a preoperative diagnosis of early gastric cancer . Clinicopathologic characteristics and surgical outcomes were analyzed . Results : All operations were performed successfully without open or laparoscopic conversion . There were 33 total gastrectomies and 67 subtotal gastrectomies with D1+&bgr ; or extended lymphadenectomy ( D2 ) . The mean total operation time and console time were 231 and 150 minutes , respectively . There were 13 postoperative morbidities and 1 postoperative mortality . The first flatus was noted on postoperative day 2.9 , soft diet was started on postoperative day 4.2 , and the mean postoperative hospital stay was 7.8 days . Although all patients were diagnosed as early gastric cancer preoperatively , the final pathology report revealed that 19 patients exhibited a depth deeper than T2 . The mean number of retrieved lymph nodes was 36.7 ( range , 11–83 ) . None of the specimens showed microscopic tumor involvement in the resection line . Conclusions : This study demonstrated that RAG with lymphadenectomy can be applied safely and effectively for patients with gastric cancer Background Robotic surgery for the treatment of gastric cancer has been reported , but the technique is not yet established . The objective of this study was to assess the feasibility and safety of our novel integrated procedure for robotic suprapancreatic D2 nodal dissection during distal gastrectomy . Methods At our hospital from January 2009 to December 2010 , a total of 25 consecutive cases of gastric cancer were treated by robotic distal gastrectomy with intracorporeal Billroth I reconstruction . These patients were enrolled in a prospect i ve study to assess the safety and feasibility of robotic distal gastrectomy with nodal dissection by our novel integrated approach , which consists of three elements : arm formation , the surgical approach , a cutting device . To evaluate the learning curves involved in this approach , clinicopathologic features and surgical outcomes were compared between the initial ( n = 12 ) and late ( n = 13 ) phases . Results All operations were completed without the need for open or conventional laparoscopic surgery . The mean operating time was 361 ± 58.1 min ( range 258–419 min ) , and blood loss recorded was 51.8 ± 38.2 ml ( range 4–123 ml ) . The median number of retrieved lymph nodes was 44.3 ± 18.4 ( range 26–95 ) . R0 resection was accomplished in all cases . There were no deaths or complications related to pancreatic damage . Operating time and surgeon console time for the late phase were significantly shorter than those for the initial phase . Conclusions Our novel robotic approach for D2 nodal dissection in gastric cancer is feasible and safe OBJECTIVE To evaluate the comparative safety and efficacy of robotic vs laparoscopic gastrectomy for early-stage gastric cancer . DESIGN Retrospective analysis . SETTING Tertiary hospital . PATIENTS Eight hundred twenty-seven patients with gastric cancer . INTERVENTIONS Between July 2005 and April 2009 , 827 patients with gastric cancer underwent 236 robotic and 591 laparoscopic radical gastrectomies with curative intent . The patients ' data were prospect ively collected and retrospectively analyzed . MAIN OUTCOME MEASURES We performed a comparative analysis between the robotic surgery group and laparoscopic surgery group for preoperative patient characteristics , intraoperative factors , and postoperative morbidity and mortality . RESULTS The robotic group was younger than the laparoscopic group , but other preoperative patient characteristics did not differ . The mean operative time for the robotic group ( 219.5 minutes ) was on average 49 minutes longer than the laparoscopic group ( 170.7 minutes ) ( P < .001 ) , while mean blood loss was significantly less in the robotic group ( 91.6 mL vs 147.9 mL ; P = .002 ) . The robotic group had mortality of 0.4 % and morbidity of 11.0 % , comparable with those of the laparoscopic group ( P > .05 ) . The number of lymph nodes retrieved per level was adequate in both groups and did not differ significantly . Robotic D1+α ( n = 5 ) , D1+β ( n = 126 ) , and D2 ( n = 105 ) dissections retrieved 27.2 , 36.7 , and 42.4 mean numbers of lymph nodes , respectively . Except for 3 cases in the laparoscopic group , all specimens had negative margins . CONCLUSIONS Our largest comparative study demonstrates robotic gastrectomy to have better short-term and comparable oncologic outcomes compared with laparoscopic gastrectomy . A robotic approach to gastric cancer is a promising alternative to laparoscopic surgery Background Robotic systems recently have been introduced to overcome technical limitations of conventional laparoscopic surgery , especially for complex procedures . Laparoscopic spleen-preserving total gastrectomy with D2 lymph node ( LN ) dissection ( LTGD2 ) is one of the most complicated procedures . We hypothesized that robotic LN dissection would be more thorough and accurate . We compared robotic spleen-preserving total gastrectomy with D2 LN dissection ( RTGD2 ) with LTGD2 to investigate the impact of robotics . Methods Clinicopathologic characteristics and short-term and long-term outcomes of  RTGD2 ( n = 51 ) versus LTGD2 ( n = 58 ) in gastric adenocarcinoma patients were extracted from a prospect ively design ed data base and analyzed retrospectively . Results There was no difference of patients ’ characteristics between groups .  Mean operation time of RTGD2 was longer than LTGD2 ( p < 0.001 ) , and no differences in tumor histology , size , location , and TNM stage were seen . Total retrieved LNs from RTGD2 was similar to LTGD2 ( mean 47.2 vs. 42.8 , respectively ) , as were retrieved LNs at splenic hilum ( 1.3 vs. 0.8 ) . However , mean numbers of retrieved LNs along the splenic artery from RTGD2 was higher than LTGD2 ( 2.3 vs. 1.0 , respectively ; p = 0.013 ) , as was also the case at the splenic hilum and artery ( 3.6 vs. 1.9 , p = 0.014 ) . Postoperative complication ( 16 vs. 22 % , p = 0.374 ) and overall and disease-free survival between the two groups were not significantly different ( p = 0.767 and p = 0.666 , respectively ) . Conclusions Robotic spleen-preserving total gastrectomy with D2 LN dissection is feasible . Operation time and retrieved total LNs and splenic hilar LNs in the robotic procedure are acceptable Background Totally laparoscopic gastrectomy ( TLG ) using intracorporeal anastomosis has gradually become mature thanks to the advancements of laparoscopic surgical instruments and the accumulation of operative experience . The goal of this study is to review our institution ’s experience with TLG for the treatment of gastric cancer . Methods A retrospective study was conducted to examine the short-term outcomes of  TLG using intracorporeally stapler or h and -sewn anastomosis performed at Sir Run Run Shaw Hospital between March 2007 and June 2015 . The details of intracorporeal anastomosis were described , and the clinicopathological data , surgical outcomes , and postoperative complications were evaluated . Results Four hundred seventy-eight patients were included in the study . Generally speaking , the patients could be divided into stapler or h and -sewn groups according to whether intracorporeal anastomosis was performed by only h and -sewn technique ( n = 97 ) or only stapling devices ( n = 381 ) . For overall patients , the mean operation time and anastomotic time were 225.7 and 30.0 min , respectively . Postoperative complications were observed in 65 patients . All of the patients recovered well without perioperative death by conservative or surgical management . Conclusions TLG using intracorporeally stapler or h and -sewn anastomosis is a reasonable option for the treatment of gastric cancer , with early data showing acceptable perioperative outcomes Background Despite recent advances in robotic urological surgery , the feasibility and clinical merit of robotic gastric surgery have not yet been fully documented . Therefore , we design ed a prospect i ve , non-r and omized study to determine the feasibility and safety of robot-assisted distal gastrectomy ( RADG ) for gastric cancer using electric cautery devices , which are more familiar to open surgery . Methods Between April 2010 and December 2012 , 181 patients treated by distal gastrectomy for gastric carcinoma were eligible for this study . According to their intent to undergo uninsured robotic surgery , 21 patients were treated with RADG ( RADG group ) while 160 patients were treated by conventional laparoscopic distal gastrectomy ( LDG group ) . Under a basic working hypothesis that the superior visualization and unique movement of the robotic arms during dissection would be closely associated with reduced amount of blood loss , even though an equivalent extension of lymph node dissection was carried out , we prospect ively collected data from patients in the RADG and LDG groups . Results All patients were successfully treated without conversion except for one patient in the RADG group who underwent conversion to laparoscopic total gastrectomy . In comparison with the patient groups , the estimated blood loss in patients in the RADG group treated with electric cautery devices only was smaller , but not significantly , than patients in the LDG group treated with ultrasonic-activated devices , although the same extent of lymph node dissection was achieved . In contrast , there were four patients ( 2.5 % ) in the LDG group who developed a pancreas fistula or intra-abdominal abscess , while no patients treated with RADG developed such complications . Conclusions RADG using electric cautery instruments without ultrasonic-activated devices is feasible and safe . The robot enables particular surgical views , called robotically-enhanced surgical anatomy , and may contribute to reducing blood loss despite the fact that only electric cautery was used Background Robotic surgery has been developed with the aim of improving surgical quality and overcoming the limitations of conventional laparoscopy in the performance of complex mini-invasive procedures . The present study was design ed to compare robotic and laparoscopic distal gastrectomy in the treatment of g 
    Output:
    
There was no significant difference between RG and LG regarding time to flatus , hospitalization , morbidity , mortality , harvested lymph nodes , and cancer recurrence .
Conclusions RG can be performed as safely as LG .
However , it will take more effort to decrease operation time and expense