Robotic esophagectomy and 3-field lymphadenectomy with intraoperative nerve monitoring

The standard of care for esophageal malignancies has evolved over the years from open transthoracic esophagectomy to a minimally invasive approach due to the reduction in surgical trauma and significant impact on postoperative outcomes. Minimally invasive approaches include video-assisted thoracoscopic surgery and robot-assisted thoracoscopic surgery. These minimally invasive approaches have an attendant learning curve that early-career surgeons are required to negotiate before achieving proficiency in the procedure. Recurrent laryngeal nerve injury is a particularly significant problem, especially in the presence of enlarged supracarinal lymph nodes, which mandate a 3-field lymphadenectomy. With technological advances and the use of intraoperative nerve monitoring, iatrogenic nerve injury can at best be avoided or at least be recognized, and corrective measures can be undertaken to reduce postoperative morbidity. In this video tutorial, we demonstrate a standard robot-assisted esophagectomy and a 3-field lymphadenectomy with the use of intraoperative nerve monitoring followed by an esophagogastric anastomosis with the triangulating stapling technique.