Robotic Esophagectomy

Robotic-assisted minimally invasive esophagectomy (RAMIE) is performed for resectable esophageal squamous cell carcinoma and adenocarcinoma, including Siewert I and II gastroesophageal junction tumors. The robotic platform (typically da Vinci Xi) provides 3D high-definition visualization, tremor filtration, and articulating wristed instruments enabling precise mediastinal dissection in confined spaces.

The McKeown three-incision approach combines abdominal and thoracic robotic phases with a left cervical anastomosis. The Ivor-Lewis approach uses abdominal robotic preparation of the gastric conduit and thoracic robotic dissection with intrathoracic anastomosis. Operative steps include circumferential mediastinal lymphadenectomy along the recurrent laryngeal nerves and subcarinal-paraesophageal stations, gastric mobilization with right gastroepiploic artery preservation, conduit creation with linear staplers, and esophagogastric anastomosis (hand-sewn or stapled).

Compared with open esophagectomy, RAMIE demonstrates lower pulmonary complications, reduced blood loss, shorter ICU stay, comparable lymph node yield, and equivalent oncologic outcomes. Pulmonary complications, anastomotic leak (10-15%), recurrent laryngeal nerve injury, chyle leak, and conduit ischemia remain key concerns. Enhanced recovery protocols with early ambulation, jejunostomy feeding, and protocolized pulmonary care reduce length of stay. Five-year survival depends on tumor stage and ranges from 30-60% for resectable disease.