Robotics and minimally invasive esophageal surgery

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Robotic platforms are increasingly utilized in abdominal and thoracic esophageal surgery.
• Key conditions managed include achalasia, gastroesophageal reflux disease, hiatal hernia, and esophageal cancer.

Purpose of the Study:

• To present a literature review of robotic surgeries for common esophageal disorders.
• To compare robotic approaches with traditional laparoscopic/thoracoscopic methods.

Main Methods:

• Literature review focusing on meta-analyses, case series, and prospective trials.
• Inclusion of one randomized controlled trial comparing hybrid robotic and open esophagectomy.
• Analysis of data for achalasia, esophageal cancer, and other indications.

Main Results:

• Robotic Heller myotomy demonstrated significantly lower intraoperative mucosal injury rates (1% vs. 24.5%) compared to laparoscopic approaches.
• Robotic esophagectomy showed a trend towards reduced vocal cord paralysis (P=0.044) versus minimally invasive esophagectomy (MIE).
• Overall, length of stay, bleeding, and major morbidity were similar across robotic and conventional techniques.

Conclusions:

• Robotic esophageal surgery is a safe alternative to laparoscopic and thoracoscopic procedures.
• Specific benefits observed in achalasia and esophageal cancer management.
• Further large-scale randomized trials are necessary to establish definitive superiority of robotic approaches.