Outcomes and complications after robot-assisted minimally invasive esophagectomy

Esophagectomy is the mainstay treatment for cancer of the esophagus. Over the past 15 years uptake in minimally invasive surgery, and in particular robotic techniques, have become increasingly popular in esophageal surgery. The team in University Medical Centre Utrecht were among the earliest to pioneer robotic-assisted minimally invasive esophagectomy (RAMIE) and have now performed in excess of 450 RAMIE procedures. We have recently published the first randomized controlled trial to assess the value of RAMIE over open McKeown esophagectomy. This paper reports on our unit’s outcomes, complications and technical development of the procedure in the world’s largest RAMIE cohort, but also incorporates available evidence from other units. Common and important complications such as anastomotic leak, pulmonary complications, chyle leak, recurrent laryngeal nerve palsy, delayed gastric emptying, diaphragmatic herniation and stricturing are all discussed. The specific value that the robot brings to our esophagectomy practice will be highlighted. This article is accompanied by several videos to illustrate the developments of specific elements of RAMIE including dissection and ligation of the thoracic duct and the robotic handsewn end-to-side sutured intrathoracic anastomosis.