The precise dissection of the vagus nerve has become a critical element in the technical chain of function-preserving gastrectomy (FPG). At the technical level, innovations such as intraoperative nerve monitoring combined with navigation by indocyanine green fluorescence, optimization of surgical approaches, robotic surgical systems, and artificial intelligence (AI) -assisted surgical planning and navigation systems have significantly enhanced the precision and feasibility of vagus nerve preservation. However, controversies persist: while preservation of the hepatic branch has become a consensus, preservation of the celiac branch still requires more high-quality evidences due to its technical difficulty and potential impact on the thoroughness of lymph node dissection. Future research directions include: determining the safety of implementing nerve-preserving, reduced surgery or even exempt from surgery in patients achieving significant downstaging after neoadjuvant therapy, as well as evaluating the oncological safety of nerve preservation in advanced gastric cancer. In conclusion, precise vagus nerve preservation is crucial for improving the postoperative quality of life of gastric cancer patients. Advancing personalized and precision surgery requires the continued integration of technological progress combined with evidence-based medicine.