A standardized protocol for robot-assisted minimally invasive esophagectomy: improving efficiency and reducing costs

Robot-assisted minimally invasive esophagectomy (RAMIE) has shown potential benefits over conventional procedures for esophageal cancer. However, uniform surgical protocols are lacking, leading to variability in outcomes and increased costs. This retrospective study included 180 patients with esophageal cancer who underwent RAMIE between May 2018 and September 2024. A standardized approach, termed counterclockwise partitioned mediastinal dissection (CPMD), was introduced in 114 of these cases. Perioperative parameters including operative time, blood loss, complications, and cost of disposable instruments, were compared between patients treated before and after protocol standardization. Among the 114 patients who received the standardized RAMIE protocol, the median thoracic console time significantly decreased to 148 min, with overall blood loss reduced to 62 ml. No conversions to open surgery were required in either cohort. Compared to the pre-standardization group, postoperative complications-including recurrent laryngeal nerve paralysis-were lower and only one patient needed reoperation. Importantly, reusing robotic instruments from the thoracic phase in the abdominal phase reduced disposable instrument costs, resulting in a savings of approximately 168,000 Japanese Yen (USD 1050) per case. Implementing a standardized RAMIE protocol enhances procedural efficiency, reduces blood loss, and lowers costs without compromising surgical or oncological outcomes. This approach may facilitate broader adoption of RAMIE as a safe and cost-effective strategy for esophageal cancer surgery.