Robotic esophagectomy: The european experience

In 2003, robot-assisted minimally invasive thoraco-laparoscopic esophagectomy (RAMIE) was developed to overcome the technical limitations of minimally invasive esophagectomy (MIE). Robotic surgery benefits from a stable three-dimensional, magnified view and articulated instruments enabling precise dissection with 7 degrees of freedom of movement. At the time of introduction of RAMIE in 2003, there were no robotic endowristed coagulating instruments available. The dissection of the greater curvature along the gastroepiploic vessels with a rigid robotic ultrasonic scalpel did not add to conventional laparoscopic dissection. Furthermore, the dexterity of the robotic arms was insufficient to reach the duodenum, greater curvature, and hiatus within a single docking. With the recently introduced robotic bipolar coagulator (vessel sealer^®) and newest generation robot (Xi^®) allowing multi-quadrant surgery, these limitations have been solved and the robotic abdominal phase could be of technical benefit. In this chapter we describe the robot-assisted minimally invasive esophagectomy with intrathoracic handsewn anastomosis in a fully robotic 4 Arm Procedure (thorax and abdomen) with the Da Vinci^® Xi (RAMIE 4).