International Journal of Clinical Case Reports 2024, Vol.14, No.4, 221-229 http://medscipublisher.com/index.php/ijccr 223 2.4 Comparison of different techniques: efficacy, safety, and recovery When comparing open, laparoscopic, and robotic-assisted gastrectomies, each technique has distinct advantages and drawbacks. Open gastrectomy provides the most comprehensive surgical access, which is crucial for advanced-stage tumors but results in higher morbidity. Laparoscopic gastrectomy offers a less invasive alternative with comparable oncologic outcomes and better postoperative recovery, particularly in early-stage cancers. Robotic-assisted surgery, while the most advanced, is still limited by cost and accessibility, though it shows potential for being the gold standard in complex cases due to its precision and reduced postoperative complications. Studies have shown that both laparoscopic and robotic surgeries lead to shorter hospital stays and quicker recovery, while open surgery remains essential for more complicated, late-stage cases (Rosa et al., 2022). 3 Advances in Minimally Invasive Gastric Cancer Surgery 3.1 Single-incision laparoscopic surgery (SILS) and its application in gastric cancer Single-incision laparoscopic surgery (SILS) is a relatively new development in minimally invasive surgery that allows surgeons to perform gastric resections through a single small incision, typically at the umbilicus (Wang, 2024a). This technique offers cosmetic benefits and a potentially quicker recovery compared to conventional multi-port laparoscopic surgery. Studies have shown that SILS is a feasible and safe option for early gastric cancer, offering similar oncologic outcomes as conventional laparoscopic surgery. However, its use in more advanced stages of gastric cancer is still under investigation, and large-scale studies are required to confirm its long-term efficacy (Son and Kim, 2014). 3.2 Endoscopic Submucosal Dissection (ESD): Indications and Effectiveness Endoscopic submucosal dissection (ESD) is a minimally invasive procedure used primarily for the treatment of early gastric cancer that is confined to the mucosa or submucosa and has no lymph node metastasis. ESD allows for en bloc resection of tumors, ensuring clear margins and reducing the risk of recurrence. It is particularly useful for small, localized tumors. Studies have demonstrated that ESD offers excellent long-term survival rates, comparable to surgical options, with fewer complications and a quicker recovery period. Its use is expanding globally, particularly in Japan and South Korea, where early detection programs are more prevalent (Ryu, 2015). 3.3 Hybrid techniques combining endoscopic and laparoscopic approaches Hybrid surgical techniques that combine both endoscopic and laparoscopic methods have emerged as promising options for treating gastric cancer, particularly in cases where traditional surgery may be overly invasive. These techniques involve using endoscopy to visualize and dissect tumors internally while laparoscopic tools assist in resecting and removing the affected tissue. This approach offers the precision of endoscopic techniques with the broader surgical access of laparoscopy. Hybrid procedures are typically used for early-stage cancers and have shown favorable outcomes, including reduced operative times and fewer complications (Su and Bu, 2023). 3.4 Patient selection criteria for minimally invasive techniques The success of minimally invasive techniques in gastric cancer depends heavily on patient selection. Ideal candidates for these procedures include those with early-stage tumors that are localized without lymph node involvement or metastasis (Wang, 2024b). Laparoscopic and endoscopic approaches are best suited for patients with early gastric cancer or those who have favorable tumor characteristics, such as size and depth of invasion. Advanced techniques like robotic surgery may be used for more complex cases, but careful assessment is required to determine the best course of action. Factors such as tumor location, patient comorbidities, and surgeon expertise also play a crucial role in determining eligibility for minimally invasive surgery (Lee & Kim, 2022). 4 Challenges and Limitations of Current Surgical Techniques 4.1 Technical challenges in robotic and laparoscopic surgeries Robotic and laparoscopic surgeries for gastric cancer, while less invasive and associated with quicker recovery times, come with several technical challenges. Laparoscopic surgeries, particularly for advanced gastric cancer, often face limitations in performing extended lymphadenectomy due to limited visualization and maneuverability. Robotic surgeries, though offering better precision and control, require longer operation times and come with
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