Background
Lymphnode involvement has been recognised to be the most significant prognostic factor after curative gastric resection for adenocarcinoma. The nodal stage based on their sites are important prognostic determinants. According to recent meta-analysis laparosocpic D2 dissection showed a longer duration but it reduces blood loss, less pain, faster bowel function recovery, and shorter hospital stay, with a similar number of harvested lymph nodes as well as a similar overall survival rate in comparison with open dissection. Robotic surgery allows a better view and precision, giving it easier and safer.

Materials and Methods
We have performed in a period interval 2006-2013, 174 gastric resections for gastric tumors (early cancer, advanced and GIST), 71 with Video-Robotic approach (40,8%).

Result
The conversion rate in minimally invasive series was of 5 cases (7%). In the robotic group a D2 lymphoadenectomy was performed in 41 cases, 23 D1-D1+ dissection and in the other cases a simple nodes sampling was required or none (GIST). Associated splenectomy was performed in 2 cases, liver resection (metastasectomies) in 1 case. When a multi-organ resection (colon, pancreas, etc.) was required, we converted in open surgery. The nodes number for D2 technique (mean 28, range 18 – 54), operative time, morbidity and oncologic outcomes, were analized and compared with a our previous open experince.

Conclusion
The video shows a series of different cases of gastric resections for tumors (adenocarcinomas and 1 neuroendocrine tumor) where D2-D1 dissections were performed using robotic technique. The node stations are indicated with numbers overlay.