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Abe et al. Mini-invasive Surg 2023;7:28 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2023.15

Original Article Open Access

Will robot-assisted minimally invasive

esophagectomy improve patient outcomes
compared to conventional minimally invasive

esophagectomy?

Tetsuya Abe , Eiji Higaki, Hironori Fujieda, Hisafumi Saito, Kiyoshi Narita, Koji Komori, Seiji Ito,
Yasuhiro Shimizu

Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Aichi Pref, Nagoya 464-8681, Japan.
Correspondence to: Tetsuya Abe, Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden,
Chikusa-ku, Aichi, Nagoya 464-8681, Japan. E-mail: tabe@aichi-cc.jp
How to cite this article: Abe T, Higaki E, Fujieda H, Saito H, Narita K, Komori K, Ito S, Shimizu Y. Will robot-assisted minimally
invasive esophagectomy improve patient outcomes compared to conventional minimally invasive esophagectomy? Mini-invasive
Surg 2023;7:28. https://dx.doi.org/10.20517/2574-1225.2023.15

Received: 20 Feb 2023 First Decision: 25 May 2023 Revised: 22 Jun 2023 Accepted: 20 Jul 2023 Published: 24 Jul 2023
Academic Editors: Fernando A. M. Herbella, Itasu Ninomiya Copy Editor: Dong-Li Li Production Editor: Dong-Li Li

Abstract
Aim: To determine if introducing a standardized minimally invasive esophagectomy (MIE) to robot-assisted MIE
(RAMIE) improves the short-term patient outcomes.
Methods: A total of 292 patients with esophageal cancer underwent thoracic esophagectomy [MIE (n = 208);
RAMIE (n = 84)] at Aichi Cancer Center Hospital between January 2019 and August 2022. The cumulative sum
(CUSUM) method was used to analyze the learning curve for RAMIE. The MIE and RAMIE surgical and
postoperative outcomes were also analyzed retrospectively. Propensity score matching was used to compensate
for the selection bias.

Results: The CUSUM plot of the console time reached a plateau in the 29th case and began to decrease in the 43rd
case. Therefore, we defined phase I (introductory phase) up to the 28th case, phase II from the 29th - 42nd case,
and phase III from the 43rd case onward. The median thoracic operative time was significantly longer in the RAMIE
group than the MIE group in phase I (P < 0.001); however, the median RAMIE console time was 227.5, 212, and
182 min in phases I-III, respectively, compared to a median MIE thoracic operative time of 232 min. The incidence
of recurrent laryngeal nerve (RLN) palsy was significantly less after phase II for RAMIE (12.5%) compared to MIE
(25%; P = 0.04). The incidence of RLN palsy was also decreased in phases II and III for RAMIE after matching
(13%; P = 0.04).

© 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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