Robotic-Assisted Esophagectomy: Current Situation and Future Perspectives

Abstract

Robotic-assisted minimally invasive esophagectomy (RAMIE) has been rapidly spreading worldwide as a novel minimally invasive approach for esophageal cancer. This narrative review aimed to elucidate the current situation and future perspectives of RAMIE for esophageal cancer. References were searched using PubMed and Embase for studies published up to 8 April 2023. Search terms included “esophagectomy” or “esophageal cancer” and “robot” or “robotic” or “robotic-assisted.” There are several different uses for the robot in esophagectomy. Overall complications are equivalent or may be less in RAMIE than in open esophagectomy and conventional (thoracoscopic) minimally invasive esophagectomy. Several meta-analyses demonstrated the possibility of RAMIE in reducing pulmonary complications, although the equivalent incidence was observed in two randomized controlled trials. RAMIE may increase the number of dissected lymph nodes, especially in the left recurrent laryngeal nerve area. Long-term outcomes are comparable between the procedures, although further research is required. Further progress in robotic technology combined with artificial intelligence is expected.

Challenges in Robotic Lung Lobectomy through the Anterior Approach

“…A similar approach has been adopted for thoracoscopic esophagectomy and mediastinal tumors with ports spanning multiple intercostal spaces. 14) The new da Vinci systems, namely X/Xi, have the capacity for camera swapping and stapling (EndoWrist; Intuitive Surgical, Tokyo, Japan). These improvements make the anterior approach more feasible by minimizing the disadvantages observed in previous systems.…”

Fully robotic side‐to‐side stapled anastomosis provides less anastomotic leakage than conventional minimally invasive approach in Ivor Lewis esophagectomy

“…In particular, intrathoracic anastomosis is considered technically demanding. Recently, robot‐assisted MIE (RAMIE) has demonstrated similar or better short‐term outcomes to conventional MIE (cMIE) in several retrospective studies and review articles 8–11 . In our institution, robotic ILE was initiated in 2021 with the expectation that the articulated function of the robotic forceps would improve anastomotic manipulation and reduce postoperative anastomotic leakage.…”