Robotic D2 Total Gastrectomy with Fluorescent Lymphatic Mapping for Gastric Cancer: Effective Use of the 4th Arm.

Minimally invasive surgery techniques have evolved remarkably over the past few decades in the field of surgical oncology, including robotic techniques for gastric malignancies. Bedside surgical assistance is often limited by operating table space or surgeon availability. Operating surgeons need to understand such limitations in robotic surgery assistance and how to maximize the effective use of the inactive 4th robotic arm (i.e., determine “where to park the 4th arm”) to obtain adequate exposure of the surgical field during robotic gastrectomy. In this video, we demonstrate how we perform robotic total gastrectomy, with a focus on how we effectively utilize the 4th robotic arm to achieve adequate exposure of the surgical field. Achieving excellent exposure of the surgical field is of paramount importance during robotic total gastrectomy for gastric cancer, and the effective use of the 4th robotic arm is extremely important for improving the safety and oncologic quality of robotic total gastrectomy.