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Khaitan et al. Mini-invasive Surg 2020;4:51 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2020.34

Review Open Access

Robotic esophagectomy: how I do it?

Puja Gaur Khaitan , John F. Lazar , Marc Margolis , Hayley R. Henderson , Thomas J. Watson 1,2
2
1,2
1,2
1,2
1 Department of Surgery, Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar
Washington Hospital Center, Washington, DC 20010, USA.
2 Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital
Center, Washington, DC 20010, USA.
Correspondence to: Dr. Puja Gaur Khaitan, Department of Surgery, Division of Thoracic and Esophageal Surgery, Georgetown
University School of Medicine, MedStar Washington Hospital Center, 110 Irving Street, NW (G253), Washington, DC 20010,
USA. E-mail: puja.g.khaitan@medstar.net
How to cite this article: Khaitan PG, Lazar JF, Margolis M, Henderson HR, Watson TJ. Robotic esophagectomy: how I do it? Mini-
invasive Surg 2020;4:51. http://dx.doi.org/10.20517/2574-1225.2020.34
Received: 9 Apr 2020 First Decision: 19 May 2020 Revised: 6 Jun 2020 Accepted: 17 Jun 2020 Published: 15 Aug 2020

Academic Editor: Noriyoshi Sawabata Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Compared to the open approach, minimally invasive esophagectomy (MIE) offers several advantages including
smaller incisions with decreased pain, improved cosmesis, and earlier return of the patient to baseline function.
Robotic-assisted minimally invasive esophagectomy (RAMIE) builds on standard MIE by offering three-
dimensional visualization, better instrument articulation, tremor filtration, and superior ergonomics, all of which
facilitate technical precision and surgeon comfort. An evolving literature demonstrates that when performed by
experienced surgeons, RAMIE leads to improved perioperative outcomes with long-term oncologic equivalency
to open approaches, and may offer advantages compared to traditional MIE. This review focuses on the key steps
of performing 3-field McKeown, 2-field Ivor Lewis, and transhiatal robotic esophagectomies, data regarding the
short- and long-term outcomes, and a brief overview of upcoming trials comparing RAMIE with MIE.

Keywords: Esophagectomy, robotic, minimally invasive esophagectomy

INTRODUCTION
Over the last two decades or more, minimally invasive approaches to esophagectomy have been adopted
with increasing frequency. The benefits of minimally invasive surgery include smaller incisions, less pain,
improved cosmesis, decreased lengths of stay, and quicker return of the patient to baseline function. When
performed for thoracic malignancies, minimally invasive resections have led to cure rates equivalent to

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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