Safety and efficacy of the Toumai robotic assisted versus the DaVinci robotic assisted radical gastrectomy for patients with gastric cancer

Safety and efficacy of the Toumai robotic assisted versus the DaVinci robotic assisted radical gastrectomy for patients with gastric cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Safety and efficacy of the Toumai robotic assisted versus the DaVinci robotic assisted radical gastrectomy for patients with gastric cancer Yuan Tian, Jiaxuan Yang, Honghai Guo, Peigang Yang, Yong Li, Liqiao Fan, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6676233/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Nov, 2025 Read the published version in BMC Surgery → Version 1 posted 11 You are reading this latest preprint version Abstract Background Robot-assisted gastrectomy (RAG) is a promising alternative treatment for gastric cancer. However, the therapeutic efficacy of the Toumai system in RAG remains unexplored. This study aimed to analyzed the outcomes of the Toumai system versus the DaVinci system in RAG. Methods This was a retrospective propensity score-matched analysis from January 2022 and March 2023. Patients who underwent RAG using the Toumai system or DaVinci Xi system were enrolled and a propensity score-matched analysis was performed in a 1:1 manner. The patients were divided into Toumai group and DaVinci group. The clinicopathological characteristics and short-term outcomes were observed. Results After propensity score matching, 64 patients each in the Toumai and DaVinci groups. There was no statistical difference between the Toumai system and the DaVinci system in terms of short-term postoperative complications (15.6% vs. 12.5%, P = 1.0), and no serious complications occurred in either group. 2 cases had bleeding and 4 cases had abdominal infection and 4 cases had respiratory tract infection in the Toumai group. 4 cases had bleeding and 1 case had deep venous thrombosis and 2 cases had respiratory tract infection in the DaVinci group. No significant differences in other clinical parameters between the groups, such as operative time, number of retrieved lymph nodes, estimated intraoperative blood loss, first flatus, length of hospital stay, time to liquid diet, time to ambulation postoperatively, drainage volume on postoperative day 1, and pain scores from postoperative day 1 to day 3 (all P ≥ 0.05). Conclusion Both the Toumai and DaVinci surgical systems demonstrate comparable clinical outcomes in RAG. The Toumai system offers a viable new option for the surgical management of gastric cancer. Gastric cancer robot-assisted gastrectomy Toumai surgical system DaVinci surgical system minimally invasive surgery Figures Figure 1 Figure 2 Figure 3 Introduction The surgical approach to gastric cancer has evolved from traditional open surgery to minimally invasive surgery (MIS), which offers improved outcomes such as quicker recovery and reduced bleeding and complications [ 1 – 3 ]. Among the advancements in MIS, robot-assisted surgery, characterized by enhanced dexterity, precision, and three-dimensional visualization, has significantly benefited surgical outcomes [ 4 – 6 ]. The DaVinci surgical system, introduced in the early 2000s, is a leading platform for robot-assisted surgery, with extensive research demonstrating its efficacy in various procedures, including gastrectomy [ 7 – 10 ]. The success of the DaVinci system has spurred the development of other robotic platforms worldwide [ 11 ]. One such innovation is the Toumai® Endoscopic Surgical System, a four-arm laparoscopic robot designed by MedBot. As of June 2023, it has been used in over 1,000 surgeries across more than 40 hospitals in China, addressing a wide range of thoracoabdominal operations such radical prostatectomy, radical pneumonectomy, radical gastrectomy, and hysterectomy. However, comparisons of surgical outcomes between the Toumai and DaVinci systems have not been explored, with safety and minimally invasive impact on the patient remaining paramount concerns for surgeons [ 12 – 14 ]. This study reports on 64 cases of robot-assisted gastrectomy (RAG) using the Toumai system and 64 cases using the DaVinci system, analyzing their clinical outcomes. Our objective is to evaluate and compare the efficacy of these two robotic platforms in performing RAG. Methods Patients RAG performed between January 2022 and March 2023 at the Fourth Hospital of Hebei Medical University using the Toumai surgical system or the DaVinci® Xi System were included in this retrospective study. All surgeries were performed by the same experienced surgical team from the Third Department of Surgery at the Fourth Hospital of Hebei Medical University, which has completed over 500 cases of RAG. This study complied with the requirements of the Declaration of Helsinki, and informed consent was obtained from patients who underwent relevant data analysis. Inclusion criteria: (1) Adult patients aged 18 to 80. (2) Gastroscopy biopsy-confirmed gastric cancer. (3) No distant metastasis (including pelvic cavity, peritoneum, liver, lung, brain, bone, etc.) determined by ultrasound or CT. (4) No history of other malignant tumors or associated organ dysfunction. (5) Willingness to undergo robotic surgery. Exclusion criteria: (1) Partial resection. (2) Multiple malignancies. (3) Combined gastrectomy or adjacent organ resection. (4) American Society of Anesthesiologists (ASA) Classification > Level III. Data collection Clinical data collected included short-term postoperative complications, baseline demographic characteristics, past medical history, postoperative pathological staging, operation time, retrieved lymph nodes in total, estimated blood loss, conversion to laparotomy, postoperative recovery records, length of stay, and visual analogue score. Technological feasibility was assessed based on the criteria that RAG surgery was performed with no conversion or major intraoperative complications, such as cardiopulmonary complications, injury to peripheral organs, unexpected resection of adjacent organs, unexpected tumor rupture, and estimated blood loss below 200 ml. Postoperative complications within 30 days after surgery were observed and graded by the Clavien-Dindo classification. estimated blood loss. Toumai® Endoscopic Surgical System Technology The Toumai® Endoscopic Surgical System is the first four-arm laparoscopic surgical robot made in China certified by the National Medical Products Administration (NMPA). The system features a 1080P three-dimensional high-definition dual CMOS electronic endoscope, lightweight lens design (weight ≤ 350g), and four highly dexterous robotic arms with a suspended design, enabling 7 degrees of freedom of movement and filtering out human hand tremors. The Toumai system consists of three parts: the Surgical Console, Robotic Arms, and Vision System (Fig. 1 ). The Surgical Console is used by the surgeon to control the system and issue instructions, featuring ergonomic design with hand controls, foot pedals, and an integrated 3D high-definition display for real-time visualization of the surgical site. The Robotic Arms can be directed from the surgical console, each comprising various segments and joints and employing specialized instruments that replicate the actions of the surgeon's hands. The Vision System includes a high-definition camera positioned around the surgical area to provide a real-time view of the surgical site. Surgical Technique RAG surgery consists of several key steps: dissection of the lesser curvature of the stomach, mobilization of the greater omentum, dissection of the subpyloric area, duodenum, upper edge of the pancreas, splenic area, resection margin, and reconstruction of the digestive tract. The patient is initially positioned supine with legs apart. Laparoscopic exploration is performed to rule out infiltration of adjacent organs and peritoneal metastasis. Five ports are placed: an 8mm trocar under the umbilicus for observation, 8mm trocars 2 cm below the right anterior axillary line and at the intersection of the midclavicular line at umbilicus level, and 3 cm below the left anterior axillary line. A 12mm trocar is placed horizontally along the midclavicular line as the assistant operating port. The trocars are spaced approximately 8 cm apart (Fig. 2 , 3 ). The procedure includes opening the hepatogastric ligament, separating the greater omentum from the transverse colon, ligating and dividing the gastroepiploic vessels, and performing a D2 lymphadenectomy [ 15 ]. Based on tumor location, the surgery may involve a total, distal, or proximal gastrectomy, followed by appropriate anastomosis techniques. Abdominal drainage tubes are placed according to the type of gastrectomy performed. Statistics Analysis Patients' characteristics were summarized using frequencies and percentages for categorical variables and mean values ± standard deviation for continuous variables. SPSS 28.0 software was used for data analysis. Student’s t-test and Mann–Whitney U test was used for continuous variables, while Pearson’s χ2 and Fisher’s exact tests were applied to categorical variables. P-values < 0.05 were considered statistically significant. Results Patients’ characteristics A total of 287 patients underwent RAG using the Toumai system or DaVinci system from January 2022 and March 2023. Among them, those who underwent Toumai (n = 83) or DaVinci (n = 204) were included. After 1:1 propensity matching analysis, there were 64 patients each in the Toumai group and DaVinci group. As shown in Table 1 , there were no significant differences in general information such as gender, age, BMI, ASA score, history of systemic diseases, and history of abdominal surgery between the two groups. As shown in Table 2 , there were no significant differences in tumor characteristics, including maximum tumor diameter, Lauren classification, surgical approach, tumor location, degree of differentiation, and pathological TNM stage, also showed no significant differences between the groups. Overall, all categories showed no significant differences between the two groups, suggesting that the patient populations and tumor characteristics were comparable. Table 1 Clinical Characteristics of the Toumai Group and the DaVinci Group after Propensity Score Matching Toumai(N = 64) DaVinci(N = 64) X 2 P value Gender 0.988 0.32 Male 54 56 Female 10 8 Age 0.251 0.616 >60 28 32 ≤ 60 36 32 BMI(kg/m2) 0.235 1.000 ≤ 20 4 4 20–25 42 44 >25 18 16 ASA -- 0.257 >2 4 12 ≤ 2 60 52 History of systemic disease 0.063 0.802 Admitted 34 36 Denied 30 28 History of abdominal disease 2.963 0.085 Admitted 16 4 Denied 48 60 Table 2 Pathologic Characteristics of the Toumai Group and the DaVinci Group after Propensity Score Matching Toumai(N = 64) DaVinci(N = 64) X 2 P value Max tumor size (cm) 0.474 0.491 >2 52 56 ≤ 2 12 8 Lauren type 0.591 0.442 Diffuse 22 28 Intestinal/mixed 42 36 Surgical resection range 0.344 1.000 proximal subtotal 2 2 distal subtotal 44 42 total gastrectomy 18 20 Tumor location 0.305 0.868 Cardiac 6 8 Body 14 16 Antrum 44 40 Degree of differentiation 0.591 0.442 Poorly differentiation 22 28 Medium-high differentiation 42 36 pTNM stage 3.302 0.252 Ⅰ 32 40 Ⅱ 20 8 Ⅲ 12 16 Postoperative recovery and complications Table 3 presents the short-term postoperative complications for both groups. Complications were classified using the Clavien-Dindo system [ 16 ]. Table 3 Short-term postoperative complication of the Toumai Group and the DaVinci Group Parameter No. (%) P Toumai (n = 64) DaVinci (n = 64) Complications 0.500 No Complications 58(90.6) 60(93.8) With Complications 6(9.4) 4(6.2) Clavien-Dindo Classification Grades I-II 10(15.6) 8(12.5) 1.0 Grade III-Ⅳ 0(0) 0(0) 0 Bleeding 2 4 Abdominal infection 4 0 Respiratory tract infection 4 2 Deep venous thrombosis 0 2 In the Toumai group, 10 patients experienced complications, all classified as Clavien-Dindo Grade 2. These included two cases of gastrointestinal bleeding, four cases of residual abdominal infection, and four cases of respiratory tract infection. The gastrointestinal bleeding, attributed to postoperative gastric mucosal damage, resolved with conservative treatment. Patients with residual abdominal infections presented with cloudy drainage fluid and postoperative fever. Gastrointestinal radiography showed no signs of anastomotic fistula. After oral rehydration and anti-inflammatory treatment, the patients’ temperatures normalized. The drainage tubes were removed once the fluid cleared, and abdominal CT scans showed no further signs of infection. Respiratory tract infections, detected through postoperative fever and confirmed via X-ray, resolved with antibiotic treatment. In the DaVinci group (n = 64), eight patients experienced complications, also all classified as Clavien-Dindo Grade 2. These included four cases of gastrointestinal bleeding, two cases of deep vein thrombosis, and two cases of respiratory tract infection. Gastrointestinal bleeding, identified within 24 hours postoperatively via abdominal drainage, was managed with conservative hemostatic therapy, and blood tests showed no abnormalities. Patients with respiratory infections and deep vein thrombosis recovered after appropriate symptomatic treatment. No Clavien-Dindo Grade 3 or higher complications occurred in either group, and there was no statistically significant difference in the overall incidence of complications between the groups. Surgical characteristics Table 4 presents the main clinical variables of both groups. No statistically significant differences were observed in operative times between the two groups. The total operative time was 199.41 ± 37.31 minutes for the Toumai group and 185.84 ± 24.73 minutes for the DaVinci group (P = 0.92). Docking times were 12.41 ± 2.14 minutes for the Toumai group and 11.81 ± 1.77 minutes for the DaVinci group (P = 0.231). Dissection times were 126.47 ± 29.17 minutes for the Toumai group and 116.19 ± 18.67 minutes for the DaVinci group (P = 0.098). Reconstruction times were 60.31 ± 14.05 minutes for the Toumai group and 57.84 ± 11.15 minutes for the DaVinci group (P = 0.439). Table 4 Main clinical variables of the Toumai Group and the DaVinci Group Toumai(N = 64) DaVinci(N = 64) P value Median Mean ±SD Median Mean ±SD Total operative time (min) 190 199.41 ± 37.31 169 185.84 ± 24.73 0.092 Docking Time 12.5 12.41 ± 2.14 12 11.81 ± 1.77 0.231 Dissection Time 128 126.47 ± 29.17 108 116.19 ± 18.67 0.098 Reconstruction Time 57 60.31 ± 14.05 58 57.84 ± 11.15 0.439 Number of retrieved lymph nodes 40.5 41.19 ± 11.70 46 44.81 ± 13.74 0.260 Estimated blood loss (ml) 30 36.67 ± 22.33 20 31.56 ± 20.81 0.313 First flatus (POD) 3 2.56 ± 0.88 3 2.72 ± 0.89 0.567 Time to liquid diet (POD) 4.5 4.73 ± 1.53 5 4.97 ± 1.33 0.269 Length of hospital stay (Days) 8 7.91 ± 1.33 8 8.09 ± 2.29 0.690 Pain on Day 1(POD) 3 2.72 ± 0.46 3 2.63 ± 0.55 0.463 Pain on Day 2(POD) 2 2.41 ± 0.50 2 2.21 ± 0.61 0.183 Pain on Day 3(POD) 2 2.10 ± 0.47 2 1.84 ± 0.63 0.075 Time to Ambulation Postoperatively 2 1.94 ± 0.83 2 1.72 ± 0.58 0.321 Drainage Volume on Postoperative Day 1 100 106.33 ± 73.47 100 98.13 ± 60.51 0.848 The number of retrieved lymph nodes was 41.19 ± 11.70 for the Toumai group and 44.81 ± 13.74 for the DaVinci group, with no significant difference (P = 0.313). Estimated intraoperative blood loss was 36.67 ± 22.33 ml for the Toumai group and 31.56 ± 20.81 ml for the DaVinci group (P = 0.313). Postoperative recovery variables, including time to first flatus, time to oral fluid intake, time to enteral nutrition, postoperative hospital stay, time to ambulation, drainage volume on the day of surgery, and subjective pain scores from days 1 to 3 postoperatively, showed no significant differences between the two groups. Discussion Robotic surgical platforms have been employed in a wide range of clinical procedures [ 17 – 19 ]. The first robotic radical gastrectomy for gastric cancer was reported in 2002 [ 20 ]. In addition to the DaVinci RAS system, several new robotic systems have recently been introduced. One such system is the Toumai RAS, which operates on a master-slave model similar to the DaVinci. The clinical effectiveness of these newer platforms still requires validation through empirical data [ 21 – 22 ]. In this study, we compared the outcomes of radical gastrectomy performed using two different robotic platforms. Our primary objective was to evaluate the differences in intraoperative, postoperative, and functional outcomes between patients who underwent the procedure with the Toumai System and those with the DaVinci System. No significant differences were observed in any of these outcomes. Before adopting the Toumai system, our team had performed over 500 robotic-assisted gastrectomies (RAG) using the DaVinci system [ 23 ]. With both systems now available at our institution, we sought to determine whether the surgical outcomes of RAG performed with the Toumai System were comparable to those with the DaVinci System. While we have been using the DaVinci System since 2019, the Toumai System was only introduced into our clinical practice in March 2023 [ 23 ]. Despite this discrepancy in experience, we found no significant differences between the two systems in terms of total operative time and console time. The surgical approach remained consistent across all cases, regardless of the platform used. We adhered to our standard radical gastrectomy with D2 lymphadenectomy, which included dissection of the lesser curvature of the stomach, mobilization of the greater omentum, dissection of the subpyloric area, duodenum, upper edge of the pancreas, splenic area, resection margin, and digestive tract reconstruction [ 15 ]. No modifications to the surgical technique were necessary when using the newer platform. Our findings suggest that the Toumai System does not present a steep learning curve [ 24 ]. Surgeons in the study adapted quickly to the system's features, such as the open console with 3D glasses and "pistol-like" handles [ 25 ]. This adaptability is reflected in the similar operative times between the two systems. Docking times were also comparable, despite differences in card shapes and connections. The initial docking time with the Toumai System was approximately 18 minutes, with subsequent procedures reduced to under 15 minutes. Our experience with radical gastrectomy aligns with existing literature regarding operative time, complication rates, and hospital stay duration [ 9 , 26 – 28 ]. However, our postoperative protocol yielded a higher number of lymph nodes detected, likely due to our extensive experience in gastric cancer surgery and skilled pathology personnel. In terms of postoperative and functional outcomes, including complication rates, length of hospital stay, time to liquid diet, time to ambulation, and postoperative pain, no significant differences were found between patients undergoing surgery with either platform. These findings suggest that the Toumai System offers a comparable safety profile and reproducibility to the well-established DaVinci System. This study is the first to compare the Toumai and DaVinci systems for radical gastrectomy. Our results are consistent with the only other comparative study of robotic platforms, in which Luo et al. analyzed data from 45 patients undergoing radical sigmoid colon resection with either the MicroHand S or DaVinci systems, finding no significant differences in perioperative or pathological outcomes [ 29 ].Robotic surgical systems hold significant potential for future innovations, including single-incision robotic surgery, remote surgery, and automated procedures [ 30 – 34 ]. The involvement of more manufacturers in developing robotic platforms could accelerate advancements in surgical technology.While this retrospective study was not randomized, no specific criteria were used to assign patients to either platform, and there were no significant differences in baseline characteristics between the two groups [ 25 ]. This study provides a comprehensive evaluation of short-term outcomes across different robotic platforms, and follow-up assessments will be conducted to evaluate long-term safety and oncological prognosis. Although this is a single-center study, our institution specializes in gastrointestinal cancer and has extensive experience with robotic and laparoscopic gastric cancer surgery. We aim to expand the scope of our research to further assess the efficiency of both robotic platforms and their application to other procedures. Conclusion The Toumai RAS system has been confirmed as safe and feasible for clinical application in gastric cancer treatment. Our data presents the preliminary outcomes of surgeries performed using this novel robotic platform, demonstrating their safety and feasibility. The surgeries achieved a high success rate, with acceptable perioperative results and no instances of conversion or severe complications. Declarations Acknowledgments Not applicable Conflicts of interest The authors declare that they have no conflict of interest. Disclosures Jiaxuan Yang, Yuan Tian, Honghai Guo, Peigang Yang, Yong Li, Liqiao Fan, Zhidong Zhang, Dong Wang, Xuefeng Zhao, Bibo Tan, Yu Liu, Qun Zhao, have no conflicts of interest or financial ties to disclose. Ethics approval and consent to participate The study was approved by the Ethics Committee of the Fourth Hospital of Hebei Medical University (No. 2023048). Informed consent or substitute for it was obtained from all patients for being included in the study. Data availability Q. Zhao had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Funding This work was supported by S&T Program of Hebei (23297701Z); Supported by Hebei Natural Science Foundation (22JCZXJC00140) ; Hebei Provincial Government-funded Clinical Talent Project (ZF2023047, ZF2025200); Medical Science Research Project of Hebei Province(20230121). Author Contribution T.Y., Y.J.and G.H. contributed to the conceptualization, methodology, software, and data curation. T.Y. and Y.J. wrote the original draft. Y.P. and L.Y.(Li Yong) were responsible for visualization, investigation, and software validation. F. L. performed formal analysis. L.Y.(Li Yong), F.L., Z.Z., and W.D. contributed to writing - review & editing, visualization, and supervision. Z.X., T.B., L.Y.(Liu Yu), and Z.Q. conducted investigations. Z.Q. conceptualized and supervised the study, contributed to methodology, writing - reviewing and editing, project administration, and funding acquisition. All authors reviewed and approved the final manuscript. References Ajani JA, D'Amico TA, Bentrem DJ, Chao J, Cooke D, Corvera C, Das P, Enzinger PC, Enzler T, Fanta P, Farjah F, Gerdes H, Gibson MK, Hochwald S, Hofstetter WL, Ilson DH, Keswani RN, Kim S, Kleinberg LR, Klempner SJ, Lacy J, Ly QP, Matkowskyj KA, McNamara M, Mulcahy MF, Outlaw D, Park H, Perry KA, Pimiento J, Poultsides GA, Reznik S, Roses RE, Strong VE, Su S, Wang HL, Wiesner G, Willett CG, Yakoub D, Yoon H, McMillian N, Pluchino LA. Gastric Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2022;20(2):167–92. Japanese Gastric Cancer Association. Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition). Gastric Cancer. 2023;26(1):1–25. Katai H, Mizusawa J, Katayama H, Morita S, Yamada T, Bando E, Ito S, Takagi M, Takagane A, Teshima S, Koeda K, Nunobe S, Yoshikawa T, Terashima M, Sasako M. Survival outcomes after laparoscopy-assisted distal gastrectomy versus open distal gastrectomy with nodal dissection for clinical stage IA or IB gastric cancer (JCOG0912): a multicentre, non-inferiority, phase 3 randomised controlled trial. Lancet Gastroenterol Hepatol. 2020;5(2):142–51. Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg. 2005;241(2):232–7. Sibio S, La Rovere F, Di Carlo S. Benefits of minimally invasive surgery in the treatment of gastric cancer. World J Gastroenterol. 2022;28(30):4227–30. Intuitive, Surgical. Inc. Annual report 2022. https://www.annualreports.com/Click/21198 Tan WS, Ta A, Kelly JD. Robotic surgery: getting the evidence right. Med J Aust. 2022;217(8):391–3. Li ZY, Zhou YB, Li TY, Li JP, Zhou ZW, She JJ, Hu JK, Qian F, Shi Y, Tian YL, Gao GM, Gao RZ, Liang CC, Shi FY, Yang K, Wen Y, Zhao YL, Yu PW, Robotic. Robotic Gastrectomy Versus Laparoscopic Gastrectomy for Gastric Cancer: A Multicenter Cohort Study of 5402 Patients in China. Ann Surg. 2023;277(1):e87–95. Laparoscopic Surgery Committee of Chinese Research Hospital Association. Li ZY, Wei B, Zhou YB, Li TY, Li JP, Zhou ZW, She JJ, Qin XG, Hu JK, Li YX, Qian F, Shi Y, Cui H, Tian YL, Gao GM, Gao RZ, Liang CC, Shi FY, Yu LJ, Yang K, Zhang SX, Yu PW, Zhao YL. Long-term oncological outcomes of robotic versus laparoscopic gastrectomy for gastric cancer: multicentre cohort study. Br J Surg. 2024;111(1):znad435. Muaddi H, Hafid ME, Choi WJ, Lillie E, de Mestral C, Nathens A, Stukel TA, Karanicolas PJ. Clinical Outcomes of Robotic Surgery Compared to Conventional Surgical Approaches (Laparoscopic or Open): A Systematic Overview of Reviews. Ann Surg. 2021;273(3):467–73. Kinross JM, Mason SE, Mylonas G, Darzi A. Next-generation robotics in gastrointestinal surgery. Nat Rev Gastroenterol Hepatol. 2020;17(7):430–40. Lu J, Zheng CH, Xu BB, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M, Tu RH, Huang ZN, Lin JL, Zheng HL, Huang CM, Li P. Assessment of Robotic Versus Laparoscopic Distal Gastrectomy for Gastric Cancer: A Randomized Controlled Trial. Ann Surg. 2021;273(5):858–67. Rosemurgy AS. Cost Computation and Profitability of Robotic Surgery. J Am Coll Surg. 2021;233(6):814–5. Childers CP, Maggard-Gibbons M. Estimation of the Acquisition and Operating Costs for Robotic Surgery. JAMA. 2018;320(8):835–6. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. 2021;24(1):1–21. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96. Boal MWE, Anastasiou D, Tesfai F, Ghamrawi W, Mazomenos E, Curtis N, Collins JW, Sridhar A, Kelly J, Stoyanov D, Francis NK. Evaluation of objective tools and artificial intelligence in robotic surgery technical skills assessment: a systematic review. Br J Surg. 2024;111(1):znad331. Kamarajah SK, Bundred J, Marc OS, Jiao LR, Manas D, Abu Hilal M, White SA. Robotic versus conventional laparoscopic pancreaticoduodenectomy a systematic review and meta-analysis. Eur J Surg Oncol. 2020;46(1):6–14. Nessa A, Shaikh S, Fuller M, Masannat YA, Kastora SL. Postoperative complications and surgical outcomes of robotic versus conventional nipple-sparing mastectomy in breast cancer: meta-analysis. Br J Surg. 2024;111(1):znad336. Hashizume M, Shimada M, Tomikawa M, Ikeda Y, Takahashi I, Abe R, Koga F, Gotoh N, Konishi K, Maehara S, Sugimachi K. Early experiences of endoscopic procedures in general surgery assisted by a computer-enhanced surgical system. Surg Endosc. 2002;16(8):1187–91. Sighinolfi MC, Rocco B, Terzoni S, Morandi A, Afonina M, Assumma S, Calcagnile T, Turri F, Sangalli M, Panio E, Sarchi L, Grasso A, Dell'orto P, Pozzi E, Ramondo A, Santangelo E, Petix M, Gaia G. New robotic systems: first head-to-head comparison between Hugo RAS and Versius CMR in the pre-clinical setting. Minerva Urol Nephrol. 2024;76(1):1–4. Byrn JC, Schluender S, Divino CM, Conrad J, Gurland B, Shlasko E, Szold A. Three-dimensional imaging improves surgical performance for both novice and experienced operators using the da Vinci Robot System. Am J Surg. 2007;193(4):519–22. Tian Y, Guo H, Hu Y, Yang P, Liu Y, Zhang Z, Ding P, Zheng T, Fan L, Zhang Z, Li Y, Zhao Q. Safety and efficacy of robotic-assisted versus laparoscopic distal gastrectomy after neoadjuvant chemotherapy for advanced gastric cancer. Surg Endosc. 2023;37(9):6761–70. Kim MS, Kim WJ, Hyung WJ, Kim HI, Han SU, Kim YW, Ryu KW, Park S. Comprehensive Learning Curve of Robotic Surgery: Discovery From a Multicenter Prospective Trial of Robotic Gastrectomy. Ann Surg. 2021;273(5):949–56. Freschi C, Ferrari V, Melfi F, Ferrari M, Mosca F, Cuschieri A. Technical review of the da Vinci surgical telemanipulator. Int J Med Robot. 2013;9(4):396–406. Tian Y, Cao S, Kong Y, Shen S, Niu Z, Zhang J, Chen D, Jiang H, Lv L, Liu X, Li Z, Zhong H, Zhou Y. Short- and long-term comparison of robotic and laparoscopic gastrectomy for gastric cancer by the same surgical team: a propensity score matching analysis. Surg Endosc. 2022;36(1):185–95. Shibasaki S, Suda K, Hisamori S, Obama K, Terashima M, Uyama I. Robotic gastrectomy for gastric cancer: systematic review and future directions. Gastric Cancer. 2023;26(3):325–38. Gong S, Li X, Tian H, Song S, Lu T, Jing W, Huang X, Xu Y, Wang X, Zhao K, Yang K, Guo T. Clinical efficacy and safety of robotic distal gastrectomy for gastric cancer: a systematic review and meta-analysis. Surg Endosc. 2022;36(5):2734–48. Luo D, Liu Y, Zhu H, Li X, Gao W, Li X, Zhu S, Yu X. The MicroHand S robotic-assisted versus Da Vinci robotic-assisted radical resection for patients with sigmoid colon cancer: a single-center retrospective study. Surg Endosc. 2020;34(8):3368–74. Vasey B, Lippert KAN, Khan DZ, Ibrahim M, Koh CH, Layard Horsfall H, Lee KS, Williams S, Marcus HJ, McCulloch P. Intraoperative Applications of Artificial Intelligence in Robotic Surgery: A Scoping Review of Current Development Stages and Levels of Autonomy. Ann Surg. 2023;278(6):896–903. Park SH, Kim YN, Hwang J, Kim KY, Cho M, Kim YM, Hyung WJ, Kim HI. Safety and feasibility of reduced-port robotic distal gastrectomy for gastric cancer: a phase I/II clinical trial using the DaVinci Single Port(SP) robotic system. Sci Rep. 2023;13(1):18578. Cheng X, Huang C, Jia W, Guo Z, Shi Y, Song Z, Feng H, Huang H, Xu S, Li H, Wang S, Zhang Y, Zhang T, Liu K, Ji X, Zhao R. Clinical status and future prospects of single-incision robotic-assisted surgery: a review. Int J Surg. 2023;109(12):4221–37. Wang J, Li J, Wang Y, Armand M, Jiang X. Remote orthopedic robotic surgery: make fracture treatment no longer limited by geography. Sci Bull (Beijing). 2023;68(1):14–7. Panesar S, Cagle Y, Chander D, Morey J, Fernandez-Miranda J, Kliot M. Artificial Intelligence and the Future of Surgical Robotics. Ann Surg. 2019;270(2):223–6. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 14 Nov, 2025 Read the published version in BMC Surgery → Version 1 posted Editorial decision: Revision requested 02 Jun, 2025 Reviewers agreed at journal 30 May, 2025 Reviewers agreed at journal 30 May, 2025 Reviews received at journal 29 May, 2025 Reviews received at journal 29 May, 2025 Reviewers agreed at journal 29 May, 2025 Reviewers agreed at journal 28 May, 2025 Reviewers invited by journal 28 May, 2025 Editor assigned by journal 26 May, 2025 Submission checks completed at journal 25 May, 2025 First submitted to journal 25 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6676233","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":463594860,"identity":"1b45ecd2-de22-4f67-88a9-9ebdc1f5bd74","order_by":0,"name":"Yuan Tian","email":"","orcid":"","institution":"the Fourth Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yuan","middleName":"","lastName":"Tian","suffix":""},{"id":463594861,"identity":"cd47bc1b-814c-4a41-a649-d9ebfee99488","order_by":1,"name":"Jiaxuan Yang","email":"","orcid":"","institution":"the Fourth Hospital of Hebei Medical 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University","correspondingAuthor":false,"prefix":"","firstName":"Yu","middleName":"","lastName":"Liu","suffix":""},{"id":463594874,"identity":"4227145c-ea75-4371-b2ea-f5560859f323","order_by":11,"name":"Qun Zhao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2UlEQVRIiWNgGAWjYDACCQglZ8DAA2YwNhCrxZh0LYkbiNYiP7v54YO3bXfSt7P3Ht3Mw2Aju+EA87MH+LQwzjlmbDi37Vnuzp5zabd5GNKMNxxgMzfAp4VZIsFMmrftcO6GGzlmQC2HEzcc4GGTwKeFTSL9G0hLusH9NyAt/wlr4ZHIAduSYHCDB6TlAGEtEhI5xYZzzh023HAmL+3mHINk45mH2czwapGfkb7xwZuyw/IGx88eu/Gmwk6273jzM7xaIK6Ds0BBxUxQPYqWUTAKRsEoGAVYAACJcUouZU3rAQAAAABJRU5ErkJggg==","orcid":"","institution":"the Fourth Hospital of Hebei Medical University","correspondingAuthor":true,"prefix":"","firstName":"Qun","middleName":"","lastName":"Zhao","suffix":""}],"badges":[],"createdAt":"2025-05-16 01:53:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6676233/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6676233/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12893-025-03273-1","type":"published","date":"2025-11-14T15:58:05+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":83784549,"identity":"4f335bd1-cddb-41d7-ae72-835494348028","added_by":"auto","created_at":"2025-06-02 16:26:29","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":114205,"visible":true,"origin":"","legend":"\u003cp\u003eVarious parts of Toumai® Endoscopic Surgical System\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6676233/v1/d790946a630a869f954276b5.png"},{"id":83784024,"identity":"3a66d820-f027-46cc-8aff-eaba1b0ee6bc","added_by":"auto","created_at":"2025-06-02 16:18:29","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":418108,"visible":true,"origin":"","legend":"\u003cp\u003eTrocar placement for RAG with the Toumai RAS System\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6676233/v1/8552e7a64605b8635cad6bdf.png"},{"id":83784020,"identity":"801854e2-2e43-4473-a58a-7c055bf584cf","added_by":"auto","created_at":"2025-06-02 16:18:29","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":479054,"visible":true,"origin":"","legend":"\u003cp\u003eTrocar placement for RAG with the DaVinci\u003csup\u003e®\u003c/sup\u003e Xi System\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6676233/v1/e184579826b9fc58e44115a2.png"},{"id":96105070,"identity":"4c8fe101-d81e-41f1-8497-b9fc7d20b9fd","added_by":"auto","created_at":"2025-11-17 16:08:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2106618,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6676233/v1/70d386fd-000f-45e7-96c0-05dddf170404.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Safety and efficacy of the Toumai robotic assisted versus the DaVinci robotic assisted radical gastrectomy for patients with gastric cancer","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe surgical approach to gastric cancer has evolved from traditional open surgery to minimally invasive surgery (MIS), which offers improved outcomes such as quicker recovery and reduced bleeding and complications [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Among the advancements in MIS, robot-assisted surgery, characterized by enhanced dexterity, precision, and three-dimensional visualization, has significantly benefited surgical outcomes [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe DaVinci surgical system, introduced in the early 2000s, is a leading platform for robot-assisted surgery, with extensive research demonstrating its efficacy in various procedures, including gastrectomy [\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The success of the DaVinci system has spurred the development of other robotic platforms worldwide [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. One such innovation is the Toumai\u0026reg; Endoscopic Surgical System, a four-arm laparoscopic robot designed by MedBot. As of June 2023, it has been used in over 1,000 surgeries across more than 40 hospitals in China, addressing a wide range of thoracoabdominal operations such radical prostatectomy, radical pneumonectomy, radical gastrectomy, and hysterectomy. However, comparisons of surgical outcomes between the Toumai and DaVinci systems have not been explored, with safety and minimally invasive impact on the patient remaining paramount concerns for surgeons [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study reports on 64 cases of robot-assisted gastrectomy (RAG) using the Toumai system and 64 cases using the DaVinci system, analyzing their clinical outcomes. Our objective is to evaluate and compare the efficacy of these two robotic platforms in performing RAG.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003eRAG performed between January 2022 and March 2023 at the Fourth Hospital of Hebei Medical University using the Toumai surgical system or the DaVinci\u0026reg; Xi System were included in this retrospective study. All surgeries were performed by the same experienced surgical team from the Third Department of Surgery at the Fourth Hospital of Hebei Medical University, which has completed over 500 cases of RAG. This study complied with the requirements of the Declaration of Helsinki, and informed consent was obtained from patients who underwent relevant data analysis.\u003c/p\u003e \u003cp\u003eInclusion criteria: (1) Adult patients aged 18 to 80. (2) Gastroscopy biopsy-confirmed gastric cancer. (3) No distant metastasis (including pelvic cavity, peritoneum, liver, lung, brain, bone, etc.) determined by ultrasound or CT. (4) No history of other malignant tumors or associated organ dysfunction. (5) Willingness to undergo robotic surgery.\u003c/p\u003e \u003cp\u003eExclusion criteria: (1) Partial resection. (2) Multiple malignancies. (3) Combined gastrectomy or adjacent organ resection. (4) American Society of Anesthesiologists (ASA) Classification\u0026thinsp;\u0026gt;\u0026thinsp;Level III.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eClinical data collected included short-term postoperative complications, baseline demographic characteristics, past medical history, postoperative pathological staging, operation time, retrieved lymph nodes in total, estimated blood loss, conversion to laparotomy, postoperative recovery records, length of stay, and visual analogue score.\u003c/p\u003e \u003cp\u003eTechnological feasibility was assessed based on the criteria that RAG surgery was performed with no conversion or major intraoperative complications, such as cardiopulmonary complications, injury to peripheral organs, unexpected resection of adjacent organs, unexpected tumor rupture, and estimated blood loss below 200 ml. Postoperative complications within 30 days after surgery were observed and graded by the Clavien-Dindo classification. estimated blood loss.\u003c/p\u003e\n\u003ch3\u003eToumai® Endoscopic Surgical System Technology\u003c/h3\u003e\n\u003cp\u003eThe Toumai\u0026reg; Endoscopic Surgical System is the first four-arm laparoscopic surgical robot made in China certified by the National Medical Products Administration (NMPA). The system features a 1080P three-dimensional high-definition dual CMOS electronic endoscope, lightweight lens design (weight\u0026thinsp;\u0026le;\u0026thinsp;350g), and four highly dexterous robotic arms with a suspended design, enabling 7 degrees of freedom of movement and filtering out human hand tremors.\u003c/p\u003e \u003cp\u003eThe Toumai system consists of three parts: the Surgical Console, Robotic Arms, and Vision System (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The Surgical Console is used by the surgeon to control the system and issue instructions, featuring ergonomic design with hand controls, foot pedals, and an integrated 3D high-definition display for real-time visualization of the surgical site. The Robotic Arms can be directed from the surgical console, each comprising various segments and joints and employing specialized instruments that replicate the actions of the surgeon's hands. The Vision System includes a high-definition camera positioned around the surgical area to provide a real-time view of the surgical site.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eSurgical Technique\u003c/h3\u003e\n\u003cp\u003eRAG surgery consists of several key steps: dissection of the lesser curvature of the stomach, mobilization of the greater omentum, dissection of the subpyloric area, duodenum, upper edge of the pancreas, splenic area, resection margin, and reconstruction of the digestive tract.\u003c/p\u003e \u003cp\u003eThe patient is initially positioned supine with legs apart. Laparoscopic exploration is performed to rule out infiltration of adjacent organs and peritoneal metastasis. Five ports are placed: an 8mm trocar under the umbilicus for observation, 8mm trocars 2 cm below the right anterior axillary line and at the intersection of the midclavicular line at umbilicus level, and 3 cm below the left anterior axillary line. A 12mm trocar is placed horizontally along the midclavicular line as the assistant operating port. The trocars are spaced approximately 8 cm apart (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The procedure includes opening the hepatogastric ligament, separating the greater omentum from the transverse colon, ligating and dividing the gastroepiploic vessels, and performing a D2 lymphadenectomy [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Based on tumor location, the surgery may involve a total, distal, or proximal gastrectomy, followed by appropriate anastomosis techniques. Abdominal drainage tubes are placed according to the type of gastrectomy performed.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eStatistics Analysis\u003c/h3\u003e\n\u003cp\u003ePatients' characteristics were summarized using frequencies and percentages for categorical variables and mean values\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation for continuous variables. SPSS 28.0 software was used for data analysis. Student\u0026rsquo;s t-test and Mann\u0026ndash;Whitney U test was used for continuous variables, while Pearson\u0026rsquo;s χ2 and Fisher\u0026rsquo;s exact tests were applied to categorical variables. P-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u0026rsquo; characteristics\u003c/h2\u003e \u003cp\u003eA total of 287 patients underwent RAG using the Toumai system or DaVinci system from January 2022 and March 2023. Among them, those who underwent Toumai (n\u0026thinsp;=\u0026thinsp;83) or DaVinci (n\u0026thinsp;=\u0026thinsp;204) were included. After 1:1 propensity matching analysis, there were 64 patients each in the Toumai group and DaVinci group. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, there were no significant differences in general information such as gender, age, BMI, ASA score, history of systemic diseases, and history of abdominal surgery between the two groups. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, there were no significant differences in tumor characteristics, including maximum tumor diameter, Lauren classification, surgical approach, tumor location, degree of differentiation, and pathological TNM stage, also showed no significant differences between the groups. Overall, all categories showed no significant differences between the two groups, suggesting that the patient populations and tumor characteristics were comparable.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical Characteristics of the Toumai Group and the DaVinci Group after Propensity Score Matching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eToumai(N\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDaVinci(N\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" 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\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.616\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI(kg/m2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.257\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of systemic disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.802\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdmitted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDenied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of abdominal disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.963\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdmitted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDenied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePathologic Characteristics of the Toumai Group and the DaVinci Group after Propensity Score Matching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eToumai(N\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDaVinci(N\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMax tumor size (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.474\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.491\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLauren type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.591\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.442\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiffuse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntestinal/mixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical resection range\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.344\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eproximal subtotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003edistal subtotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etotal gastrectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.305\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.868\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntrum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDegree of differentiation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.591\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.442\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoorly differentiation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedium-high differentiation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epTNM stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.302\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.252\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅠ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅡ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅢ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePostoperative recovery and complications\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the short-term postoperative complications for both groups. Complications were classified using the Clavien-Dindo system [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eShort-term postoperative complication of the Toumai Group and the DaVinci Group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNo. (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eToumai (n\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDaVinci (n\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.500\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58(90.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60(93.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWith Complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClavien-Dindo Classification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrades I-II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade III-Ⅳ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdominal infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory tract infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeep venous thrombosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the Toumai group, 10 patients experienced complications, all classified as Clavien-Dindo Grade 2. These included two cases of gastrointestinal bleeding, four cases of residual abdominal infection, and four cases of respiratory tract infection. The gastrointestinal bleeding, attributed to postoperative gastric mucosal damage, resolved with conservative treatment. Patients with residual abdominal infections presented with cloudy drainage fluid and postoperative fever. Gastrointestinal radiography showed no signs of anastomotic fistula. After oral rehydration and anti-inflammatory treatment, the patients\u0026rsquo; temperatures normalized. The drainage tubes were removed once the fluid cleared, and abdominal CT scans showed no further signs of infection. Respiratory tract infections, detected through postoperative fever and confirmed via X-ray, resolved with antibiotic treatment.\u003c/p\u003e \u003cp\u003eIn the DaVinci group (n\u0026thinsp;=\u0026thinsp;64), eight patients experienced complications, also all classified as Clavien-Dindo Grade 2. These included four cases of gastrointestinal bleeding, two cases of deep vein thrombosis, and two cases of respiratory tract infection. Gastrointestinal bleeding, identified within 24 hours postoperatively via abdominal drainage, was managed with conservative hemostatic therapy, and blood tests showed no abnormalities. Patients with respiratory infections and deep vein thrombosis recovered after appropriate symptomatic treatment.\u003c/p\u003e \u003cp\u003eNo Clavien-Dindo Grade 3 or higher complications occurred in either group, and there was no statistically significant difference in the overall incidence of complications between the groups.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSurgical characteristics\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the main clinical variables of both groups. No statistically significant differences were observed in operative times between the two groups. The total operative time was 199.41\u0026thinsp;\u0026plusmn;\u0026thinsp;37.31 minutes for the Toumai group and 185.84\u0026thinsp;\u0026plusmn;\u0026thinsp;24.73 minutes for the DaVinci group (P\u0026thinsp;=\u0026thinsp;0.92). Docking times were 12.41\u0026thinsp;\u0026plusmn;\u0026thinsp;2.14 minutes for the Toumai group and 11.81\u0026thinsp;\u0026plusmn;\u0026thinsp;1.77 minutes for the DaVinci group (P\u0026thinsp;=\u0026thinsp;0.231). Dissection times were 126.47\u0026thinsp;\u0026plusmn;\u0026thinsp;29.17 minutes for the Toumai group and 116.19\u0026thinsp;\u0026plusmn;\u0026thinsp;18.67 minutes for the DaVinci group (P\u0026thinsp;=\u0026thinsp;0.098). Reconstruction times were 60.31\u0026thinsp;\u0026plusmn;\u0026thinsp;14.05 minutes for the Toumai group and 57.84\u0026thinsp;\u0026plusmn;\u0026thinsp;11.15 minutes for the DaVinci group (P\u0026thinsp;=\u0026thinsp;0.439).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMain clinical variables of the Toumai Group and the DaVinci Group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eToumai(N\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eDaVinci(N\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003cp\u003e\u0026plusmn;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003cp\u003e\u0026plusmn;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal operative time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e199.41\u0026thinsp;\u0026plusmn;\u0026thinsp;37.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e185.84\u0026thinsp;\u0026plusmn;\u0026thinsp;24.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDocking Time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e12.41\u0026thinsp;\u0026plusmn;\u0026thinsp;2.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e11.81\u0026thinsp;\u0026plusmn;\u0026thinsp;1.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.231\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDissection Time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e126.47\u0026thinsp;\u0026plusmn;\u0026thinsp;29.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e116.19\u0026thinsp;\u0026plusmn;\u0026thinsp;18.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReconstruction Time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e60.31\u0026thinsp;\u0026plusmn;\u0026thinsp;14.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e57.84\u0026thinsp;\u0026plusmn;\u0026thinsp;11.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.439\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of retrieved lymph nodes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e41.19\u0026thinsp;\u0026plusmn;\u0026thinsp;11.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e44.81\u0026thinsp;\u0026plusmn;\u0026thinsp;13.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.260\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEstimated blood loss (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e36.67\u0026thinsp;\u0026plusmn;\u0026thinsp;22.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e31.56\u0026thinsp;\u0026plusmn;\u0026thinsp;20.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst flatus (POD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.567\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime to liquid diet (POD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.73\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e4.97\u0026thinsp;\u0026plusmn;\u0026thinsp;1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.269\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of hospital stay (Days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.91\u0026thinsp;\u0026plusmn;\u0026thinsp;1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e8.09\u0026thinsp;\u0026plusmn;\u0026thinsp;2.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.690\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain on Day 1(POD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.463\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain on Day 2(POD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.183\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain on Day 3(POD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e1.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime to Ambulation Postoperatively\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e1.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrainage Volume on Postoperative Day 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e106.33\u0026thinsp;\u0026plusmn;\u0026thinsp;73.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e98.13\u0026thinsp;\u0026plusmn;\u0026thinsp;60.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.848\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe number of retrieved lymph nodes was 41.19\u0026thinsp;\u0026plusmn;\u0026thinsp;11.70 for the Toumai group and 44.81\u0026thinsp;\u0026plusmn;\u0026thinsp;13.74 for the DaVinci group, with no significant difference (P\u0026thinsp;=\u0026thinsp;0.313). Estimated intraoperative blood loss was 36.67\u0026thinsp;\u0026plusmn;\u0026thinsp;22.33 ml for the Toumai group and 31.56\u0026thinsp;\u0026plusmn;\u0026thinsp;20.81 ml for the DaVinci group (P\u0026thinsp;=\u0026thinsp;0.313).\u003c/p\u003e \u003cp\u003ePostoperative recovery variables, including time to first flatus, time to oral fluid intake, time to enteral nutrition, postoperative hospital stay, time to ambulation, drainage volume on the day of surgery, and subjective pain scores from days 1 to 3 postoperatively, showed no significant differences between the two groups.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eRobotic surgical platforms have been employed in a wide range of clinical procedures [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The first robotic radical gastrectomy for gastric cancer was reported in 2002 [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In addition to the DaVinci RAS system, several new robotic systems have recently been introduced. One such system is the Toumai RAS, which operates on a master-slave model similar to the DaVinci. The clinical effectiveness of these newer platforms still requires validation through empirical data [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, we compared the outcomes of radical gastrectomy performed using two different robotic platforms. Our primary objective was to evaluate the differences in intraoperative, postoperative, and functional outcomes between patients who underwent the procedure with the Toumai System and those with the DaVinci System. No significant differences were observed in any of these outcomes.\u003c/p\u003e \u003cp\u003eBefore adopting the Toumai system, our team had performed over 500 robotic-assisted gastrectomies (RAG) using the DaVinci system [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. With both systems now available at our institution, we sought to determine whether the surgical outcomes of RAG performed with the Toumai System were comparable to those with the DaVinci System. While we have been using the DaVinci System since 2019, the Toumai System was only introduced into our clinical practice in March 2023 [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Despite this discrepancy in experience, we found no significant differences between the two systems in terms of total operative time and console time.\u003c/p\u003e \u003cp\u003eThe surgical approach remained consistent across all cases, regardless of the platform used. We adhered to our standard radical gastrectomy with D2 lymphadenectomy, which included dissection of the lesser curvature of the stomach, mobilization of the greater omentum, dissection of the subpyloric area, duodenum, upper edge of the pancreas, splenic area, resection margin, and digestive tract reconstruction [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. No modifications to the surgical technique were necessary when using the newer platform.\u003c/p\u003e \u003cp\u003eOur findings suggest that the Toumai System does not present a steep learning curve [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Surgeons in the study adapted quickly to the system's features, such as the open console with 3D glasses and \"pistol-like\" handles [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This adaptability is reflected in the similar operative times between the two systems. Docking times were also comparable, despite differences in card shapes and connections. The initial docking time with the Toumai System was approximately 18 minutes, with subsequent procedures reduced to under 15 minutes.\u003c/p\u003e \u003cp\u003eOur experience with radical gastrectomy aligns with existing literature regarding operative time, complication rates, and hospital stay duration [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. However, our postoperative protocol yielded a higher number of lymph nodes detected, likely due to our extensive experience in gastric cancer surgery and skilled pathology personnel.\u003c/p\u003e \u003cp\u003eIn terms of postoperative and functional outcomes, including complication rates, length of hospital stay, time to liquid diet, time to ambulation, and postoperative pain, no significant differences were found between patients undergoing surgery with either platform. These findings suggest that the Toumai System offers a comparable safety profile and reproducibility to the well-established DaVinci System.\u003c/p\u003e \u003cp\u003eThis study is the first to compare the Toumai and DaVinci systems for radical gastrectomy. Our results are consistent with the only other comparative study of robotic platforms, in which Luo et al. analyzed data from 45 patients undergoing radical sigmoid colon resection with either the MicroHand S or DaVinci systems, finding no significant differences in perioperative or pathological outcomes [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].Robotic surgical systems hold significant potential for future innovations, including single-incision robotic surgery, remote surgery, and automated procedures [\u003cspan additionalcitationids=\"CR31 CR32 CR33\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The involvement of more manufacturers in developing robotic platforms could accelerate advancements in surgical technology.While this retrospective study was not randomized, no specific criteria were used to assign patients to either platform, and there were no significant differences in baseline characteristics between the two groups [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study provides a comprehensive evaluation of short-term outcomes across different robotic platforms, and follow-up assessments will be conducted to evaluate long-term safety and oncological prognosis. Although this is a single-center study, our institution specializes in gastrointestinal cancer and has extensive experience with robotic and laparoscopic gastric cancer surgery. We aim to expand the scope of our research to further assess the efficiency of both robotic platforms and their application to other procedures.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe Toumai RAS system has been confirmed as safe and feasible for clinical application in gastric cancer treatment. Our data presents the preliminary outcomes of surgeries performed using this novel robotic platform, demonstrating their safety and feasibility. The surgeries achieved a high success rate, with acceptable perioperative results and no instances of conversion or severe complications.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosures\u0026nbsp;\u003c/strong\u003eJiaxuan Yang, Yuan Tian, Honghai Guo, Peigang Yang, Yong Li, Liqiao Fan, Zhidong Zhang, Dong Wang, Xuefeng Zhao, Bibo Tan, Yu Liu, Qun Zhao, have no conflicts of interest or financial ties to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e The study was approved by the Ethics Committee of the Fourth Hospital of Hebei Medical University (No. 2023048). Informed consent or substitute for it was obtained from all patients for being included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003eQ. Zhao had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003eThis work was supported by S\u0026amp;T Program of Hebei (23297701Z); Supported by Hebei Natural Science Foundation (22JCZXJC00140) ; Hebei Provincial Government-funded Clinical Talent Project (ZF2023047, ZF2025200); Medical Science Research Project of Hebei Province(20230121).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eT.Y., Y.J.and G.H. contributed to the conceptualization, methodology, software, and data curation. T.Y. and Y.J. wrote the original draft. Y.P. and L.Y.(Li Yong) were responsible for visualization, investigation, and software validation. F. L. performed formal analysis. L.Y.(Li Yong), F.L., Z.Z., and W.D. contributed to writing - review \u0026amp; editing, visualization, and supervision. Z.X., T.B., L.Y.(Liu Yu), and Z.Q. conducted investigations. Z.Q. conceptualized and supervised the study, contributed to methodology, writing - reviewing and editing, project administration, and funding acquisition. All authors reviewed and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAjani JA, D'Amico TA, Bentrem DJ, Chao J, Cooke D, Corvera C, Das P, Enzinger PC, Enzler T, Fanta P, Farjah F, Gerdes H, Gibson MK, Hochwald S, Hofstetter WL, Ilson DH, Keswani RN, Kim S, Kleinberg LR, Klempner SJ, Lacy J, Ly QP, Matkowskyj KA, McNamara M, Mulcahy MF, Outlaw D, Park H, Perry KA, Pimiento J, Poultsides GA, Reznik S, Roses RE, Strong VE, Su S, Wang HL, Wiesner G, Willett CG, Yakoub D, Yoon H, McMillian N, Pluchino LA. Gastric Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2022;20(2):167\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJapanese Gastric Cancer Association. Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition). Gastric Cancer. 2023;26(1):1\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKatai H, Mizusawa J, Katayama H, Morita S, Yamada T, Bando E, Ito S, Takagi M, Takagane A, Teshima S, Koeda K, Nunobe S, Yoshikawa T, Terashima M, Sasako M. Survival outcomes after laparoscopy-assisted distal gastrectomy versus open distal gastrectomy with nodal dissection for clinical stage IA or IB gastric cancer (JCOG0912): a multicentre, non-inferiority, phase 3 randomised controlled trial. Lancet Gastroenterol Hepatol. 2020;5(2):142\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg. 2005;241(2):232\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSibio S, La Rovere F, Di Carlo S. Benefits of minimally invasive surgery in the treatment of gastric cancer. World J Gastroenterol. 2022;28(30):4227\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIntuitive, Surgical. Inc. Annual report 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.annualreports.com/Click/21198\u003c/span\u003e\u003cspan address=\"https://www.annualreports.com/Click/21198\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTan WS, Ta A, Kelly JD. Robotic surgery: getting the evidence right. Med J Aust. 2022;217(8):391\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi ZY, Zhou YB, Li TY, Li JP, Zhou ZW, She JJ, Hu JK, Qian F, Shi Y, Tian YL, Gao GM, Gao RZ, Liang CC, Shi FY, Yang K, Wen Y, Zhao YL, Yu PW, Robotic. Robotic Gastrectomy Versus Laparoscopic Gastrectomy for Gastric Cancer: A Multicenter Cohort Study of 5402 Patients in China. Ann Surg. 2023;277(1):e87\u0026ndash;95. Laparoscopic Surgery Committee of Chinese Research Hospital Association.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi ZY, Wei B, Zhou YB, Li TY, Li JP, Zhou ZW, She JJ, Qin XG, Hu JK, Li YX, Qian F, Shi Y, Cui H, Tian YL, Gao GM, Gao RZ, Liang CC, Shi FY, Yu LJ, Yang K, Zhang SX, Yu PW, Zhao YL. Long-term oncological outcomes of robotic versus laparoscopic gastrectomy for gastric cancer: multicentre cohort study. Br J Surg. 2024;111(1):znad435.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuaddi H, Hafid ME, Choi WJ, Lillie E, de Mestral C, Nathens A, Stukel TA, Karanicolas PJ. Clinical Outcomes of Robotic Surgery Compared to Conventional Surgical Approaches (Laparoscopic or Open): A Systematic Overview of Reviews. Ann Surg. 2021;273(3):467\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKinross JM, Mason SE, Mylonas G, Darzi A. Next-generation robotics in gastrointestinal surgery. Nat Rev Gastroenterol Hepatol. 2020;17(7):430\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLu J, Zheng CH, Xu BB, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M, Tu RH, Huang ZN, Lin JL, Zheng HL, Huang CM, Li P. Assessment of Robotic Versus Laparoscopic Distal Gastrectomy for Gastric Cancer: A Randomized Controlled Trial. Ann Surg. 2021;273(5):858\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRosemurgy AS. Cost Computation and Profitability of Robotic Surgery. J Am Coll Surg. 2021;233(6):814\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChilders CP, Maggard-Gibbons M. Estimation of the Acquisition and Operating Costs for Robotic Surgery. JAMA. 2018;320(8):835\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJapanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. 2021;24(1):1\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santiba\u0026ntilde;es E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoal MWE, Anastasiou D, Tesfai F, Ghamrawi W, Mazomenos E, Curtis N, Collins JW, Sridhar A, Kelly J, Stoyanov D, Francis NK. Evaluation of objective tools and artificial intelligence in robotic surgery technical skills assessment: a systematic review. Br J Surg. 2024;111(1):znad331.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKamarajah SK, Bundred J, Marc OS, Jiao LR, Manas D, Abu Hilal M, White SA. Robotic versus conventional laparoscopic pancreaticoduodenectomy a systematic review and meta-analysis. Eur J Surg Oncol. 2020;46(1):6\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNessa A, Shaikh S, Fuller M, Masannat YA, Kastora SL. Postoperative complications and surgical outcomes of robotic versus conventional nipple-sparing mastectomy in breast cancer: meta-analysis. Br J Surg. 2024;111(1):znad336.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHashizume M, Shimada M, Tomikawa M, Ikeda Y, Takahashi I, Abe R, Koga F, Gotoh N, Konishi K, Maehara S, Sugimachi K. Early experiences of endoscopic procedures in general surgery assisted by a computer-enhanced surgical system. Surg Endosc. 2002;16(8):1187\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSighinolfi MC, Rocco B, Terzoni S, Morandi A, Afonina M, Assumma S, Calcagnile T, Turri F, Sangalli M, Panio E, Sarchi L, Grasso A, Dell'orto P, Pozzi E, Ramondo A, Santangelo E, Petix M, Gaia G. New robotic systems: first head-to-head comparison between Hugo RAS and Versius CMR in the pre-clinical setting. Minerva Urol Nephrol. 2024;76(1):1\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eByrn JC, Schluender S, Divino CM, Conrad J, Gurland B, Shlasko E, Szold A. Three-dimensional imaging improves surgical performance for both novice and experienced operators using the da Vinci Robot System. Am J Surg. 2007;193(4):519\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTian Y, Guo H, Hu Y, Yang P, Liu Y, Zhang Z, Ding P, Zheng T, Fan L, Zhang Z, Li Y, Zhao Q. Safety and efficacy of robotic-assisted versus laparoscopic distal gastrectomy after neoadjuvant chemotherapy for advanced gastric cancer. Surg Endosc. 2023;37(9):6761\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim MS, Kim WJ, Hyung WJ, Kim HI, Han SU, Kim YW, Ryu KW, Park S. Comprehensive Learning Curve of Robotic Surgery: Discovery From a Multicenter Prospective Trial of Robotic Gastrectomy. Ann Surg. 2021;273(5):949\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFreschi C, Ferrari V, Melfi F, Ferrari M, Mosca F, Cuschieri A. Technical review of the da Vinci surgical telemanipulator. Int J Med Robot. 2013;9(4):396\u0026ndash;406.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTian Y, Cao S, Kong Y, Shen S, Niu Z, Zhang J, Chen D, Jiang H, Lv L, Liu X, Li Z, Zhong H, Zhou Y. Short- and long-term comparison of robotic and laparoscopic gastrectomy for gastric cancer by the same surgical team: a propensity score matching analysis. Surg Endosc. 2022;36(1):185\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShibasaki S, Suda K, Hisamori S, Obama K, Terashima M, Uyama I. Robotic gastrectomy for gastric cancer: systematic review and future directions. Gastric Cancer. 2023;26(3):325\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGong S, Li X, Tian H, Song S, Lu T, Jing W, Huang X, Xu Y, Wang X, Zhao K, Yang K, Guo T. Clinical efficacy and safety of robotic distal gastrectomy for gastric cancer: a systematic review and meta-analysis. Surg Endosc. 2022;36(5):2734\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuo D, Liu Y, Zhu H, Li X, Gao W, Li X, Zhu S, Yu X. The MicroHand S robotic-assisted versus Da Vinci robotic-assisted radical resection for patients with sigmoid colon cancer: a single-center retrospective study. Surg Endosc. 2020;34(8):3368\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVasey B, Lippert KAN, Khan DZ, Ibrahim M, Koh CH, Layard Horsfall H, Lee KS, Williams S, Marcus HJ, McCulloch P. Intraoperative Applications of Artificial Intelligence in Robotic Surgery: A Scoping Review of Current Development Stages and Levels of Autonomy. Ann Surg. 2023;278(6):896\u0026ndash;903.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark SH, Kim YN, Hwang J, Kim KY, Cho M, Kim YM, Hyung WJ, Kim HI. Safety and feasibility of reduced-port robotic distal gastrectomy for gastric cancer: a phase I/II clinical trial using the DaVinci Single Port(SP) robotic system. Sci Rep. 2023;13(1):18578.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheng X, Huang C, Jia W, Guo Z, Shi Y, Song Z, Feng H, Huang H, Xu S, Li H, Wang S, Zhang Y, Zhang T, Liu K, Ji X, Zhao R. Clinical status and future prospects of single-incision robotic-assisted surgery: a review. Int J Surg. 2023;109(12):4221\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang J, Li J, Wang Y, Armand M, Jiang X. Remote orthopedic robotic surgery: make fracture treatment no longer limited by geography. Sci Bull (Beijing). 2023;68(1):14\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePanesar S, Cagle Y, Chander D, Morey J, Fernandez-Miranda J, Kliot M. Artificial Intelligence and the Future of Surgical Robotics. Ann Surg. 2019;270(2):223\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Gastric cancer, robot-assisted gastrectomy, Toumai surgical system, DaVinci surgical system, minimally invasive surgery","lastPublishedDoi":"10.21203/rs.3.rs-6676233/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6676233/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eRobot-assisted gastrectomy (RAG) is a promising alternative treatment for gastric cancer. However, the therapeutic efficacy of the Toumai system in RAG remains unexplored. This study aimed to analyzed the outcomes of the Toumai system versus the DaVinci system in RAG.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis was a retrospective propensity score-matched analysis from January 2022 and March 2023. Patients who underwent RAG using the Toumai system or DaVinci Xi system were enrolled and a propensity score-matched analysis was performed in a 1:1 manner. The patients were divided into Toumai group and DaVinci group. The clinicopathological characteristics and short-term outcomes were observed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAfter propensity score matching, 64 patients each in the Toumai and DaVinci groups. There was no statistical difference between the Toumai system and the DaVinci system in terms of short-term postoperative complications (15.6% vs. 12.5%, P\u0026thinsp;=\u0026thinsp;1.0), and no serious complications occurred in either group. 2 cases had bleeding and 4 cases had abdominal infection and 4 cases had respiratory tract infection in the Toumai group. 4 cases had bleeding and 1 case had deep venous thrombosis and 2 cases had respiratory tract infection in the DaVinci group. No significant differences in other clinical parameters between the groups, such as operative time, number of retrieved lymph nodes, estimated intraoperative blood loss, first flatus, length of hospital stay, time to liquid diet, time to ambulation postoperatively, drainage volume on postoperative day 1, and pain scores from postoperative day 1 to day 3 (all P\u0026thinsp;\u0026ge;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eBoth the Toumai and DaVinci surgical systems demonstrate comparable clinical outcomes in RAG. The Toumai system offers a viable new option for the surgical management of gastric cancer.\u003c/p\u003e","manuscriptTitle":"Safety and efficacy of the Toumai robotic assisted versus the DaVinci robotic assisted radical gastrectomy for patients with gastric cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-02 16:18:24","doi":"10.21203/rs.3.rs-6676233/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-02T17:09:12+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"4322507982030453031897778153818281627","date":"2025-05-30T13:43:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"233755338666239375074321440819864189496","date":"2025-05-30T12:07:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-29T11:01:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-29T06:17:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"74696463130264138804116410709791668737","date":"2025-05-29T04:02:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"328654740337487987147906786640949448469","date":"2025-05-28T21:43:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-28T11:55:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-26T16:03:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-25T21:26:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2025-05-25T13:52:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b2c1cdf8-be32-412a-b817-101ed9b490d3","owner":[],"postedDate":"June 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-17T16:02:07+00:00","versionOfRecord":{"articleIdentity":"rs-6676233","link":"https://doi.org/10.1186/s12893-025-03273-1","journal":{"identity":"bmc-surgery","isVorOnly":false,"title":"BMC Surgery"},"publishedOn":"2025-11-14 15:58:05","publishedOnDateReadable":"November 14th, 2025"},"versionCreatedAt":"2025-06-02 16:18:24","video":"","vorDoi":"10.1186/s12893-025-03273-1","vorDoiUrl":"https://doi.org/10.1186/s12893-025-03273-1","workflowStages":[]},"version":"v1","identity":"rs-6676233","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6676233","identity":"rs-6676233","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}