Robotic-assisted minimally invasive esophagectomy: experience at the University of Pittsburgh Medical Center

Robotic-assisted minimally invasive esophagectomy (RAMIE) is increasingly used in the treatment of resectable esophageal cancer. This is a report on the current technique of RAMIE at University of Pittsburgh Medical Center (UPMC), including a summary of early data on 65 patient outcomes reported in an ongoing esophageal cancer database. To date, we have performed over 200 cases of RAMIE at UPMC from September 2013 to July 2024, and the analysis of the data will be presented soon. The practice has evolved into a near-total RAMIE experience for several surgeons, while others remain in a learning curve. It is our experience that the initial performance of RAMIE requires strong mentoring by an experienced robotic surgeon. However, at this time, we are unable to provide guidelines for specific case numbers to achieve proficiency. As more patients with esophageal cancer are treated with robotic-assisted minimally invasive esophagectomy (MIE) at UPMC, data have shown that patient outcomes are not compromised compared with that of traditional MIE. In fact, RAMIE may demonstrate superiority in the median number of lymph nodes harvested, which could contribute to increased accuracy in pathologic staging. This approach has developed a strong surgeon preference for both new graduates and experienced MIE surgeons alike.