Cranial Approach to the Gastrosplenic Ligament During Robotic Spleen-Preserving Splenic Hilar Lymphadenectomy for Advanced Proximal Gastric Cancer

BACKGROUND: During robotic total gastrectomy (RTG) for advanced proximal gastric cancer, splenic hilar lymphadenectomy is technically difficult because of the complexity of the vascular anatomy at the splenic hilum. In this report, surgical techniques and initial experience with the cranial approach to the gastrosplenic ligament during robotic spleen-preserving splenic hilar lymphadenectomy (RSPSHL) are presented. MATERIALS AND METHODS: This procedure was performed for 15 patients with advanced proximal gastric cancer who underwent RTG from January 2021 to December 2024. RESULTS: Operative time was 383 (290-546) minutes, and estimated blood loss was 43 (5-80) g. The required time for RSPSHL was 85 (50-195) minutes. The numbers of retrieved lymph nodes in total and in the splenic hilum were 54 (40-71) and 4 (2-7). There were no conversions to laparotomy and no postoperative complications of Clavien-Dindo grade ≥III. CONCLUSIONS: This surgical approach provides an excellent operative view at the splenic hilum, making it safe and precise to perform RSPSHL.