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[30]
designed to compare RAMIE to MIE in a randomized controlled setting . The study includes four centers
from China and will focus on patients with esophageal squamous cell carcinoma (SCC). The primary
endpoint of the study is 5-year overall survival, with secondary endpoints of 3-year overall and disease-free
survival, 5-year disease-free survival, short-term outcomes, and quality of life. The hypothesis of the trial is
that RAMIE will result in equivalent oncologic outcomes and long-term quality of life, along with shorter
operative times, lower perioperative complications, and shorter hospital stays, when compared to MIE.

The REVATE trial, a two-center, open-label RCT of esophageal SCC, will compare lymph node dissection
[25]
along the RLN during RAMIE vs. MIE . The two institutions participating in this RCT are from China
and Taiwan, where SCC is more prominent than esophageal adenocarcinoma, favoring upper or middle
esophageal tumors where dissection of lymph nodes around the RLNs is critical. The study, while
meaningful for that patient population, will be difficult to apply to Western cohorts comprised primarily of
patients with adenocarcinoma of the distal esophagus or esophagogastric junction.

CONCLUSION
Robotic approaches to esophagectomy are being utilized with increased frequency and improve
upon established techniques of MIE by offering superior dexterity, maneuverability, ergonomics, and
visualization. Randomized and non-randomized studies have demonstrated equivalent oncologic
outcomes between robotic and open esophagectomies, with superior results for the robotic approach in
terms of hospital stay, postoperative morbidity, and overall quality of life. As surgeons become trained in
robotic techniques and implement them further into their treatment armamentarium, the use of RAMIE
for appropriately selected cases of esophageal malignancy or other end-stage esophageal disease will
undoubtedly, continue to increase. With the introduction of novel and competing robotic technologies, the
hope is that their cost will decrease, allowing further penetration into the marketplace.

DECLARATIONS
Authors’ contributions
Made substantial contributions to the conception and design of the manuscript, and performed data
analysis and interpretation: Khaitan PG
Contributed to manuscript writing and editing: Lazar JF, Henderson HR, Watson TJ
Provided technical and material support: Margolis M

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2020.