Hospital Completes First Fully Robot-Assisted Laparoscopic Proximal Gastrectomy with Kamikawa Anastomosis

Background

Gastroesophageal junction adenocarcinoma is a form of cancer occurring where the esophagus meets the stomach. Treatment for elderly patients often requires balancing oncologic radicality with efforts to preserve digestive function and quality of life, especially when comorbidities such as diabetes and post-radiofrequency ablation atrial fibrillation are present. In December 2025, a 71-year-old female patient presented to the Tongzhou campus of Beijing Friendship Hospital with upper abdominal discomfort and a sensation of choking after eating.

Diagnostic evaluation including gastroscopy, endoscopic ultrasound, and abdominopelvic imaging confirmed gastroesophageal junction adenocarcinoma. Following diagnosis, the gastrointestinal surgery team initiated a four-cycle neoadjuvant regimen of targeted therapy combined with chemotherapy and immunotherapy. Reassessment after treatment showed significant tumor shrinkage, indicating suitability for radical surgery. The case was managed by the team at the General Surgery Center under Director Zhang Jun.

What was achieved

The gastrointestinal surgery team at Beijing Friendship Hospital's Tongzhou campus, led by Director Zhang Jun, successfully performed the hospital's first fully da Vinci robot-assisted laparoscopic radical proximal gastrectomy combined with Kamikawa esophagogastric double muscular flap anastomosis. The procedure adhered to oncologic principles, including complete tumor resection at the gastroesophageal junction and systematic regional lymph node dissection. It was conducted entirely under robotic assistance.

The surgery proceeded smoothly with low blood loss. Postoperatively, care followed enhanced recovery after surgery (ERAS) principles provided by the gastrointestinal surgery nursing team. The patient passed gas and began ambulation on the second postoperative day. An upper gastrointestinal contrast study one week after surgery confirmed good anastomotic healing with smooth passage of contrast and no evidence of leakage or stenosis. The patient completed dietary transition and was discharged recovered. This marked the first such fully robotic Kamikawa procedure at the hospital.

How it works

Proximal gastrectomy involves surgical removal of the upper portion of the stomach along with the affected gastroesophageal junction to achieve radical tumor resection while attempting to preserve as much gastric function as possible. After resection, digestive continuity must be restored through anastomosis between the esophagus and the remnant stomach. Traditional direct connections can lead to postoperative reflux of bile and acid into the esophagus.

The Kamikawa anastomosis technique addresses this by creating a double muscular flap from the anterior wall of the remnant stomach. These flaps are carefully freed, trimmed, and sutured in layers to form a physiological valve-like structure at the join with the esophagus. This design provides a natural anti-reflux barrier, ensures adequate blood supply to the anastomosis, and minimizes tension. The approach aims to reduce risks of moderate to severe reflux esophagitis, anastomotic leakage, and stricture compared with conventional methods. It is recognized as a frontier technique in function-preserving gastrointestinal surgery.

The fully robotic approach using the da Vinci system allows surgeons to operate from a console with high-definition three-dimensional magnified visualization and instruments offering seven degrees of freedom. This facilitates precise dissection, lymph node clearance, flap creation, and microscopic layered suturing in a minimally invasive manner.

What it means for international patients

Beijing Friendship Hospital maintains an International Medical Center at its Xicheng and Tongzhou campuses dedicated to serving international patients. The center offers multilingual support, including English-language services with 24-hour English telephone consultation available. Physicians in the center are selected for their expertise and language capabilities, and the hospital has experience providing care to patients from overseas, including those seeking robotic-assisted procedures.

This case illustrates the hospital's engagement with advanced robotic techniques in gastrointestinal oncology and function-preserving reconstruction. International patients interested in similar procedures or seeking care at the facility should contact the hospital directly to confirm current availability, individual eligibility, and suitability for their specific medical condition. Coordination through the International Medical Center can facilitate appointments and support services.

About the hospital

Beijing Friendship Hospital is a tertiary Class A comprehensive hospital affiliated with Capital Medical University. Founded in 1952 as one of the first large hospitals established in the capital with assistance from the Soviet government and Red Cross, it is located in Beijing with campuses in Xicheng, Tongzhou, and Shunyi districts. The hospital integrates clinical care, teaching, research, prevention, healthcare, and rehabilitation across approximately 50 clinical and technical departments.

It features strengths in digestive diseases, including a National Clinical Research Center for Digestive Diseases, general surgery, tumor treatment, liver and kidney transplantation, critical care, and infectious diseases including tropical medicine. It was among the earliest institutions in China to provide medical services for foreign guests and senior officials. The hospital operates an International Medical Center and has achieved an A+ rating in national performance assessments for tertiary public hospitals.