Initial experience of complete portal robotic esophagectomy for esophageal carcinoma in semi-prone position under single-lumen insertion for anaesthesia.

Although robot-assisted esophagectomy has been widely used for the treatment of esophageal cancer (EC), no unified surgical technique is available. Thus, we summarized our own technique of robotic portal esophagectomy with four arms (RPE-4) for the surgical treatment of EC. A total of 22 patients with RPE-4 between June 2018 and October 2023 were included in the study. These patients received RPE-4 in the semi-prone position for thoracic procedures and in the supine position for abdominal procedures using the Da Vinci Si/Xi system. Four arms of the Da Vinci Si/Xi system combined with a 12-mm assistant port were used in all cases. Single-lumen tracheal tube insertion was performed for anesthesia, with the use of CO₂ insufflation. The mean age of the entire cohort was 62.4±5.4 years, and 77.3% (17/22) of the patients were male. All patients completed surgeries successfully without perioperative death or conversion to open surgery. The median operative time was 325.0 min [interquartile range (IQR), 296.3-391.3 min], and the median blood loss was 100.0 mL (IQR, 100.0-125.0 mL). The median number of harvested lymph nodes (LNs) was 28.0 (IQR, 21.3-45.3), and the median length of postoperative stay was 9.0 days (IQR, 6.8-12.5 days). There was no intraoperative complication. Four patients had postoperative complications, but all of them were cured by conservative therapy. In conclusion, RPE-4 under single-lumen insertion for anaesthesia with artificial pneumothorax in the semi-prone position was a safe and effective technique for surgical treatment of EC.