Robot-assisted thoracoscopic hybrid esophagectomy in the semi-prone position under pneumothorax

We performed robot-assisted thoracoscopic hybrid esophagectomy using the da Vinci Surgical System and demonstrated the potential benefit of this minimally invasive lymphadenectomy. Between April 2010 and October 2011, four patients with intrathoracic esophageal cancer underwent hybrid esophagectomy in the semi-prone position using a 3-arm standard da Vinci and a conventional thoracoscopic maneuver. All thoracoscopic procedures were completed using a robot-assisted technique. Robot-assisted thoracoscopic esophagectomy in the semi-prone position is safe and technically feasible. A hybrid procedure that combined standard da Vinci with conventional thoracosopic maneuvers overcomes the difficulties associated with using a standard da Vinci.