Robotic Surgery for Gastric Cancer: from Japan toward Asia and the World

In Japan, robotic surgery for gastric cancer has been covered by public health insurance since 2018, and the number of cases has been increasing every year, with nearly 8,000 cases performed annually at present. Our hospital started laparoscopic surgery in 2010 and robotic surgery in 2014 for gastric/EGJ cancer, and the number of cases experienced has reached approximately 2,000 and 700, respectively. In recent years, we have reported that robotic surgery is effective in more advanced cases (advanced cancer, after chemotherapy cases, total gastrectomy, obesity) and can bring out its advantages. We also consider it an advantage that the quality of surgery does not depend so much on the skill of the assistant. In addition, the hospital has as its mission to contribute to the international community. We have accepted many trainee surgeons from abroad to promote minimally invasive gastric cancer surgery. We have also actively performed live surgeries overseas to demonstrate our surgical techniques and provided education in the form of hands-on training plus lectures. However, the cost and insurance system for robotic surgery are major obstacles to its widespread use in each country. In the future, it is expected that cost issues will be addressed and that remote instruction will be incorporated to ensure that the use of robotic surgery is appropriate to the actual conditions in each region.