Abstract
Compared to the open approach, minimally invasive esophagectomy (MIE) offers several advantages including smaller incisions with decreased pain, improved cosmesis, and earlier return of the patient to baseline function. Robotic-assisted minimally invasive esophagectomy (RAMIE) builds on standard MIE by offering three-dimensional visualization, better instrument articulation, tremor filtration, and superior ergonomics, all of which facilitate technical precision and surgeon comfort. An evolving literature demonstrates that when performed by experienced surgeons, RAMIE leads to improved perioperative outcomes with long-term oncologic equivalency to open approaches, and may offer advantages compared to traditional MIE. This review focuses on the key steps of performing 3-field McKeown, 2-field Ivor Lewis, and transhiatal robotic esophagectomies, data regarding the short- and long-term outcomes, and a brief overview of upcoming trials comparing RAMIE with MIE.
Highlights
Over the last two decades or more, minimally invasive approaches to esophagectomy have been adopted with increasing frequency
This report was followed by the first transhiatal robotic esophagectomy in 2003 and the first McKeown robotic esophagectomy with cervical anastomosis in 2004[8,9]
While the initial experiences with roboticassisted minimally invasive esophagectomy (RAMIE) were associated with higher complication rates, subsequent reports have shown that RAMIE can be performed with superior perioperative outcomes, and equivalent oncologic survival when compared to open and traditional minimally invasive approaches[14,15]
Summary
Over the last two decades or more, minimally invasive approaches to esophagectomy have been adopted with increasing frequency. Four robotic ports are placed, along with a liver retractor in the right upper quadrant and assistant port in the right lower quadrant [A: (c) camera port; (a) assistant port]; the greater omentum is divided after identifying the right gastroepiploic arcade (B, red arrow) and the dissection is carried up to the short gastric vessels (C); the stomach is rotated to the right and posterior attachments are divided (D); after ensuring circumferential dissection of the conduit, the mediastinal Penrose drain is delivered into the field (E); a 4-5 cm gastric conduit is created (E and F) and indocyanine green testing of the conduit is conducted prior to transecting the stomach (G); a transition stitch can be placed where there is a clear demarcation in perfusion (G insert); once the stomach is transected, two parallel lines are marked on the conduit to ensure that the conduit is pulled into the neck without torsion (H); a pyloric drainage procedure may be performed (I). A number of publications have confirmed the lower incidence of RLN neuropraxia and vocal cord paralysis with RAMIE when compared to traditional MIE[26,27]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
