Robot-assisted esophagectomy may be a promising alternative to the conventional thoracoscopic approach

Introduction: We started robot-assisted esophagectomy (RE) in 2012 and have been performing it as an institutional standard approach since it was reimbursed in the national insurance system in 2018. Though the phase III ROBOT trial showed a significant reduction of postoperative morbidity in RE compared to open esophagectomy (OE), the evidence regarding the comparison between RE and conventional thoracoscopic esophagectomy (TE) is insufficient. We have reported significantly less postoperative morbidity (p=0.03) including less pulmonary complication (p=0.006) in RE comparing to TE using propensity score matching, despite the prolonged operation time in RE (Ann Surg Oncol. 2020).
Aim: To review the current evidence of RE and to demonstrate our standardized RE technique and updated outcomes.
Results: By February 2021, 73 REs were performed. Thoracic and console time were 346 and 291 min, respectively. Intraoperative blood loss was 80 g and the number of harvested thoracic nodes is 23. There was no conversion from RE to TE nor OE. Overall postoperative morbidity (C-D Grade 3 or higher) was 16% (12/73) and postoperative recurrent laryngeal nerve palsy (C-D Grade 2 or higher) was 11% (8/73). There was no postoperative mortality.
Summary: RE was safe and feasible and may be a promising alternative to the conventional thoracoscopic approach.