Experience-Based Procedure Card for Robotic McKeown's Esophagectomy Using SSI Mantra Indian Robotic System

This study aimed to develop a comprehensive procedural roadmap for performing McKeown's esophagectomy using the SSI Mantra robotic system and evaluate its feasibility, surgical efficiency, and short-term outcomes. The research focused on addressing the lack of detailed guidance for this procedure with the SSI Mantra system and assessing its impact on oncological results, morbidity, and patient recovery. A prospective single-arm study was conducted on 26 patients undergoing robotic McKeown's esophagectomy at a tertiary oncologic center using the SSI Mantra robotic system. The procedural roadmap included preoperative optimization, operating room configuration, anesthesia protocols, patient positioning, port placement, docking strategies, and instrumentation. Data were collected on operative times, blood loss, lymph node yield, complications, and postoperative recovery. All procedures were completed robotically without conversions. Mean operative time was 7 h (console: 6 h; docking: 50 min), with 96.6 mL blood loss. Lymph node yield averaged 21, and all resections achieved R0 margins. Postoperative complications included anastomotic leak (7.7%, 2/26), chyle leak (3.8%, 1/26), hoarseness (7.7%, 2/26), pulmonary issues (11.5%, 3/26), and delayed gastric emptying (7.7%, 2/26). Mean hospital stay was 4.5 ± 1.74 days, with 96.2% of patients catheter-free by postoperative day 1. No conduit necrosis, surgical site infections, atrial fibrillation, or 30-day mortality occurred. The SSI Mantra robotic system enables precise, minimally invasive McKeown's esophagectomy with favorable short-term outcomes, including high oncological efficacy and low morbidity. The procedural roadmap optimizes surgical efficiency and reproducibility. Further studies are needed to validate long-term outcomes and refine techniques.