{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T11:57:28Z","timestamp":1792151848634,"version":"4.4.0"},"reference-count":18,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T00:00:00Z","timestamp":1789862400000},"content-version":"vor","delay-in-days":262,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Asian J Endoscop Surgery"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Robotic gastrectomy (RG) for gastric cancer reduces morbidity and achieves long\u2010term outcomes comparable to laparoscopy. However, RG is typically a solo\u2010surgeon procedure performed by expert console surgeons, limiting trainees' operative experience. To address this issue, we developed Laparoscopic and Robotic procedures Combined Surgery (LARCS), in which the patient\u2010side surgeon (PSS) performs selected surgical maneuvers, including dissection, clipping, and stapling, using laparoscopic instruments under the supervision of the console surgeon.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively analyzed 96 patients who underwent robotic distal or subtotal gastrectomy at Kitasato University Hospital between January 2019 and December 2023. Patients were divided into a conventional RG group (CRG;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200960) and a LARCS group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200936). Propensity scores were estimated based on age, sex, body mass index, American Society of Anesthesiologists status, and clinical T and N categories. Cardinality matching within a 0.2\u2010standard\u2010deviation caliper of the logit of the propensity score yielded 23 matched pairs, with all absolute standardized mean differences for the matching covariates &lt;\u20090.1. Perioperative outcomes and PSS participation were compared.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After matching, adequate balance was achieved for all matching covariates, with absolute standardized mean differences ranging from 0 to 0.062. Operative time was 406\u2009min in the LARCS group and 373\u2009min in the CRG group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.110). Estimated blood loss tended to be greater with LARCS (51 vs. 6\u2009mL,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.070). Any postoperative complication occurred in 6 and 5 patients, respectively (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20091.000), and major complications occurred in 2 and 0 patients, respectively (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.500). Median PSS operative time was 108\u2009min, corresponding to 26.6% of the total operative time in LARCS, versus 0\u2009min in CRG (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LARCS provided patient\u2010side trainees with supervised, instrument\u2010based first\u2010operator participation for approximately one\u2010quarter of the operative time, supporting its feasibility as a complementary approach to trainee participation during robotic gastrectomy. Further prospective studies incorporating objective competency\u2010based assessments are required to determine its educational effectiveness and safety.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ases.70383","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:05:45Z","timestamp":1789949145000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Laparoscopic and Robotic Procedures Combined Surgery (\n                    <scp>LARCS<\/scp>\n                    ): A Novel Approach to Trainee Participation in Robotic Gastrectomy"],"prefix":"10.1111","volume":"19","author":[{"given":"Motohiro","family":"Chuman","sequence":"first","affiliation":[{"name":"Department of Upper Gastrointestinal Surgery Kitasato University School of Medicine  Sagamihara Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1983-4692","authenticated-orcid":false,"given":"Hiroki","family":"Harada","sequence":"additional","affiliation":[{"name":"Department of Upper Gastrointestinal Surgery Kitasato University School of Medicine  Sagamihara Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9787-2889","authenticated-orcid":false,"given":"Kei","family":"Hosoda","sequence":"additional","affiliation":[{"name":"Department of Surgery Shonan Kamakura General Hospital  Kamakura Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Niihara","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery International University of Health and Welfare Mita Hospital  Tokyo 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Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9383-4754","authenticated-orcid":false,"given":"Yusuke","family":"Kumamoto","sequence":"additional","affiliation":[{"name":"Department of General\u2010Pediatric Hepato Biliary Pancreatic Surgery Kitasato University School of Medicine  Sagamihara Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8492-0300","authenticated-orcid":false,"given":"Keishi","family":"Yamashita","sequence":"additional","affiliation":[{"name":"Division of Advanced Surgical Oncology, Department of Research and Development Center for New Medical Frontiers Kitasato University School of Medicine  Sagamihara Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6857-8736","authenticated-orcid":false,"given":"Naoki","family":"Hiki","sequence":"additional","affiliation":[{"name":"Department of Upper 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