Surgical team configuration, technical errors, and workload in robotic distal gastrectomy
In brief
Three-arm plus two-port setup reduces errors by 10 and workload in robotic gastrectomy
In a propensity-matched series of 67 patients, the 3-arm + 2-port configuration resulted in about ten fewer technical errors (average 43 vs 53) and markedly lower workload scores for both surgeons (median 8 vs 12) and assistants (median 6 vs 10) compared with the traditional 4-arm + 1-port layout. Short-term recovery was also improved, although console time and complication rates were unchanged, suggesting team setup may enhance intraoperative performance.
- Journal
- Surgical endoscopy (Q1)
- Published
- 10 September 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Debang Zhang, Junjie Wang, Yeqian Zhang, Qiushi Tang, Xiang Xia, Zizhen Zhang
- PMID
- 42722910
- DOI
- 10.1007/s00464-026-13312-4
Why clinicians should know about it
- Picked for Gastrointestinal and Colorectal Surgery (paper of the day, 16 September 2026): Team configuration reduces errors in robotic distal gastrectomy
Abstract
BACKGROUND: Robotic distal gastrectomy requires coordinated task allocation between the console surgeon and bedside assistant. Whether a laparoscopic-like "3-arm+2-port" configuration is associated with better technical performance and lower surgical workload compared with the conventional "4-arm+1-port" configuration remains unclear. METHODS: This single-center prospective cohort study included 84 patients undergoing robotic distal gastrectomy from September 2025 to March 2026. After variable-ratio propensity score matching, 45 patients in the "3-arm+2-port" group and 22 in the "4-arm+1-port" group were analyzed. Technical errors were assessed from operative videos using Observational Clinical Human Reliability Analysis. Workload was evaluated separately for primary surgeons and assistants. RESULTS: After matching, covariate balance was substantially improved. The "3-arm+2-port" group had fewer total technical errors than the "4-arm+1-port" group (42.6 (7.2) vs. 52.8 (6.9); P < .001), with significant differences in phase 3 (11.4 (3.5) vs. 15.7 (4.1); adjusted P < .001) and phase 6 (9.0 (2.7) vs. 14.1 (3.0); adjusted P < .001). Grade 2 bleeding, tissue slippage, heat burn, and Hem-o-lok slippage were also less frequent. Overall workload scores were lower for primary surgeons (8 (7-9) vs. 12 (9-13); P < .001) and assistants (6 (5-8) vs. 10 (8.25-11); P < .001). Operative time, docking time, blood loss, and short-term recovery outcomes were more favorable, whereas console time, time-adjusted technical error rate, lymph node harvest, and complications did not differ significantly. CONCLUSIONS: In robotic distal gastrectomy, the laparoscopic-like "3-arm+2-port" configuration was associated with fewer technical errors, lower team workload, and more favorable short-term recovery, although the time-adjusted technical error rate did not differ significantly. These findings suggest that surgical team configuration is a potentially modifiable factor associated with intraoperative performance and teamwork efficiency.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.