Laparoscopic gastrectomy is a well-established but technically demanding treatment against gastric cancer. Robotic gastrectomy, developed to overcome these limitations, has gained popularity in Japan since national health insurance coverage began in 2018. This study comparing matched patient pairs treated between 2023–2024 found that robotic gastrectomy reduced blood loss, conversions to open surgery, and hospital stays. Robotic distal gastrectomy also lowered complications and infections, supporting adoption to improve outcomes with minimally invasive surgery in Japan.