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Liu et al. Mini-invasive Surg 2020;4:44 I http://dx.doi.org/10.20517/2574-1225.2020.20 Page 7 of 10

Table 5. Operative positions in RAMIE
Merits Limitations
Left lateral decubitus position Similar to open resection and does not require Need single-lung ventilation with more
repositioning in the case of a conversion to open postoperative pulmonary complications.
surgery
Prone position Takes advantage of gravity to displace the lung from the Need repositioning in the case of a conversion
dorsal thoracic structures and the esophagus. to open surgery
Excellent exposure of the operative field.
Allows for double-lung ventilation with less
postoperative pulmonary complications
Semi-prone position Has benefits of both the prone position and left lateral Relatively complicated
decubitus position
RAMIE: robot-assisted minimally invasive esophagectomy

Table 6. Prospects of RAMIE
1 Tactile function
2 Forceps tip shape change function
3 Automatic forceps switch function
4 Flexible camera
5 Artificial intelligence
6 Miniaturized operating robot body and wrist
7 Break the monopoly of the Da Vinci system
RAMIE: robot-assisted minimally invasive esophagectomy

PROSPECTS FOR RAMIE
Although RAMIE has a number of advantages that can overcome the shortcomings of MIE, there are still
many problems that need to be resolved [Table 6]. For example, to perform surgery more safely, if possible
we would like to add tactile function to the robot. To shorten the operative time, a forceps tip with shape
changing function, automatic forceps switching function, and flexible camera are expected. Artificial
intelligence is another exciting feature that is being developed. To reduce interference, we are looking
forward to the development and manufacture of an operating robot with a miniaturized body and wrists.
In addition, to break the monopoly of the Da Vinci system, many surgical robot companies worldwide
are working on the development and manufacture of new robot surgery systems, which could bring lower
costs.

DECLARATIONS
Authors’ contributions
Made substantial contributions to the conception and design of the study and performed data analysis and
interpretation: Liu J, Motoyama S
Performed data acquisition, as well as provided administrative, technical, and material support: Sato Y,
Wakita A, Kawakita Y, Nagaki Y, Fujita H, Imai K, Minamiya Y

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.