Standardization and short-term outcomes of robot-assisted minimally invasive esophagectomy in the semi-prone position

Robot-assisted minimally invasive esophagectomy (RAMIE) has recently been developed and is increasingly performed for thoracic esophageal and esophagogastric junction (EGJ) cancers. At our institute, we performed RAMIE in the semi-prone position using the da Vinci Xi system with two- or three-field lymphadenectomy in 91 patients with resectable thoracic esophageal or EGJ cancers between October 2018 and March 2023. During this period, we improved and standardized the surgical procedures to perform precise and safe mediastinal lymphadenectomies and minimize postoperative complications. The rates of major operative morbidities (C-D grade, ≥ I) were acceptable (recurrent laryngeal nerve paralysis, 6.6%; pneumonia, 9.9%; atelectasis, 6.7%; anastomotic leak, 14.3%). Both operative and 30-day mortality rates were 0%. In this technical note, we present our standardized surgical techniques for RAMIE in the semi-prone position for esophageal and EGJ cancers.