Gastric resections serve as a treatment for both benign and malignant pathologies. The extent of gastric resection and reconstruction techniques are affected by the nature of the pathology and the location or extent of the disease. Reconstruction techniques are based on the complications that may arise due to each new anatomic configuration. For pathologies involving the distal two-thirds of the stomach, distal gastrectomy with Roux-en-Y reconstruction has proven to have better overall outcomes and provide a better quality of life to patients. In this chapter we describe a robotic approach to distal gastrectomy with Roux-en-Y reconstruction.