Minimizing operative time for robotic gastrectomy in cancer: Analysis of the major factors for four detailed steps

Background/Aims: We outlined the major factors for minimizing the operative time of robotic-assisted gastrectomy (RAG) during the initial learning period. Methodology: We performed correlation analysis and multivariate linear regression for detailed operation steps including preparing, docking, console and anastomosis time. Results: Forty patients underwent RAG for cancer. By Pearson analysis, case number (r = -0.313; P = 0.049) and body mass index (BMI) (r = 0.368; P = 0.019) were found to be correlated with total operation time. Multivariate linear regression with backward elimination showed that BM1 and case number significantly affected total operation time. A detailed four-step analysis showed that docking time was significantly affected by intraoperative complications. Conclusions: In conclusion, we recommend a V-shape port placement as an important surgical factor for preparation and docking time to avoid unnecessary intraoperative trial errors. In addition, selecting lower-BMI patients would be helpful in shortening the time to mastery of console, which is the most timeconsuming operative step of the robotic procedure for robotic-naive surgeons.