First series of da Vinci single-port robotic-assisted cervical oesophagectomy: single-centre IDEAL stage 2a/2b study

Recent advances in robotic technology, particularly the da Vinci single-port (SP) system, have improved transcervical mediastinoscopic access by minimizing robotic arm collisions in confined spaces.

This study, based on IDEAL (Idea, Development, Exploration, Assessment, Long-term) framework, describes the first consecutive da Vinci SP robotic-assisted cervical oesophagectomy (RACE) procedures in patients with oesophageal carcinoma performed at the University Hospital Mainz. Patient demographics, neoadjuvant treatment, resection margins, lymph node yield, intraoperative parameters, postoperative recovery, complications, and mortality were assessed.

The study included 20 patients with primarily squamous cell carcinoma, with 70% of all patients having received neoadjuvant treatment. The surgical procedure demonstrated feasibility, evidenced by a 90% R0 resection rate and a mean(standard deviation) lymph node yield of 31(7). The mean(standard deviation) total operative time was 332(88) minutes, and the active console time was 91(48) minutes. Notably, there were no intraoperative complications or conversions. Patients experienced minimal postoperative pain, with no need for epidural or intercostal catheter analgesia; by postoperative day 5, all patients received analgesia on demand. Most patients began ambulating on the first postoperative day, and the median hospital length of stay was 8 (range 5-86) days. Postoperative complications included pneumonia in five patients and anastomotic leakage in four. Two patients died: one from fulminant pulmonary embolism and one from multiple organ failure secondary to sepsis following pneumonia and anastomotic insufficiency.

The da Vinci SP system was successfully used for the first time in a clinical series of RACE procedures. SP RACE offers comparable operating times and lymph node retrieval to robotic transthoracic procedures, low postoperative pain and rapid recovery. However, the current scope of the SP RACE procedure is limited, and its outcomes warrant further prospective investigation to better define its role, refine patient selection, and evaluate long-term results.