Right-first bilateral transcervical and transhiatal single-port robotic esophagectomy using the da Vinci SP system

Transthoracic esophagectomy remains the standard surgical approach for esophageal cancer but may be unsuitable for patients with poor pulmonary reserve. To reduce thoracic invasiveness, transcervical esophagectomy has been developed as a non-transthoracic alternative. This technique was initially established using a left cervical approach and has subsequently evolved through the adoption of bilateral transcervical approaches and the introduction of multi-port robotic systems. This article describes a right-first bilateral transcervical and transhiatal esophagectomy using the da Vinci SP system. The procedure consists of right-first and left transcervical phases followed by a transhiatal phase performed using the same single-port robotic platform. The SP system allows three articulated instruments to be deployed through a single access port, facilitating stable tracheal retraction and precise mediastinal dissection. A right-first strategy enables most upper and middle mediastinal dissection to be completed from the right side, potentially minimizing the extent of the left cervical approach.