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Erodotou et al. Mini-invasive Surg 2023;7:35 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2023.95

Review Open Access

Format for safe introduction of robotic

esophagectomy

Maria Erodotou, Sjoerd M. Lagarde, Bas P.L. Wijnhoven, Pieter C. van der Sluis
Department of Esophagogastric Surgery, Erasmus University Medical Center, Rotterdam 3015 GD, The Netherlands.

Correspondence to: Maria Erodotou, Department of Esophagogastric Surgery, Erasmus University Medical Center, Dr.
Molewaterplein 40, Rotterdam 3015 GD, The Netherlands. E-mail: mariaerodotou23@outlook.com

How to cite this article: Erodotou M, Lagarde SM, Wijnhoven BPL, van der Sluis PC. Format for safe introduction of robotic
esophagectomy. Mini-invasive Surg 2023;7:35. https://dx.doi.org/10.20517/2574-1225.2023.95

Received: 9 Aug 2022 First Decision: 26 Sep 2023 Revised: 12 Oct 2023 Accepted: 19 Oct 2023 Published: 24 Oct 2023

Academic Editors: Itasu Ninomiya, Biondi Alberto Copy Editor: Pei-Yun Wang Production Editor: Pei-Yun Wang

Abstract
The aim of this study is to review the current literature on the learning curve for robotic-assisted minimally invasive
esophagectomy (RAMIE) and explore strategies for introducing and implementing RAMIE. A literature search of
electronic databases (Pubmed and Science Direct) was conducted using multiple combinations and synonyms of
the keywords “esophageal cancer”, “robotic esophagectomy”, “RAMIE”, and “learning curve” up to March 31, 2023.
In total, eighteen studies were included. Fourteen studies reported on surgeons with experience in minimally
invasive surgery. Seven studies reported on surgeons with prior robotic experience for benign diseases or
experience as observant or assistant in robotic surgery or experience on cadaveric robotic training. Four studies
reported on a specific training pathway. The learning curve was mostly analyzed using the cumulative sum control
chart (CUSUM). The most commonly used measured variables were the total operation time, the thoracic and
abdominal console time, the lymph node yield, and vocal cord palsy rates. Τhe learning curve plateaus for the total
operative time, the vocal cord palsy rates, and the lymph node yield varied between 20-80, 15-80, and 18-73 cases,
respectively. At present, several centers are increasingly adopting RAMIE for esophageal cancer. Education about
the learning curve of RAMIE is crucial for the training pathway in order to safely introduce RAMIE in centers
without pre-existing robotic esophagectomy experience.

Keywords: Robotic esophagectomy, RAMIE, esophageal cancer, learning curve

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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