Robotics and minimally invasive esophageal surgery

The robotic platform has permeated esophageal surgery both in the abdominal and thoracic approaches. The most widely studied entities include achalasia, gastroesophageal reflux disease, hiatal hernia and esophageal cancer. A literature review of robotic surgeries for the management of the above mentioned disorders is presented. Data is limited to meta-analyses, case series, or small prospective trials in the different indications. One exception is a randomized controlled trial looking at outcomes in esophageal cancer being managed with a hybrid robotic versus open approach. Overall differences when comparing laparoscopic or thoracoscopic surgery to robotic are few. These differences are best highlighted in the achalasia and esophageal cancer literature. There are less intraoperative mucosal injuries in robotic Heller myotomy. A large meta analysis found a rate of 1% versus 24.5% mucosal injury rate favoring the robotic versus laparoscopic Heller myotomy methods. With respect to esophagectomy data, there is slightly less vocal cord paralysis in the robotic versus MIE data, with a P value of 0.044. However, length of stay, intraoperative bleeding and major morbidity are similar across the various indications. Robotic esophageal surgery is a safe alternative to laparoscopic/thoracoscopic techniques. Further large-scale randomized trials are needed to fully ascertain if it yields superior outcomes.