[Advances in minimally invasive surgical techniques for esophageal cancer]

Over the past two decades, minimally invasive esophageal surgery has evolved from initial technical exploration into an era of diversification and precision. This article systematically reviews the current mainstream minimally invasive esophagectomy techniques and their evolutionary logic. Currently, minimally invasive McKeown esophagectomy, with its advantage of thorough lymph node dissection, remains the most widely used standard procedure, with multiple RCTs confirming its non-inferior long-term survival compared to open surgery. The non-transthoracic approach, represented by inflatable mediastinoscopy combined with laparoscopy, provides an important alternative for patients with impaired cardiopulmonary function. Robotic-assisted surgery has enhanced precision, and preliminary applications of single-port robotic systems and domestically developed platforms have shown promising prospects. Uniportal thoracoscopic minimally invasive esophagectomy, as a modification of the McKeown procedure, further reduces trauma while ensuring oncological radicality. Intraoperative indocyanine green (ICG) fluorescence imaging has the most robust evidence in assessing anastomotic perfusion, with additional value in lymphatic mapping and thoracic duct visualization. Artificial intelligence has achieved preliminary success in anatomical structure recognition and surgical phase segmentation. In conclusion, minimally invasive esophageal surgery is continuously evolving toward reduced trauma, enhanced functional preservation, and more precise decision-making.