Comparison of conventional and robotic-assisted minimally invasive esophagectomy for esophageal cancer

Conventional minimally invasive esophagectomy (MIE) and robotic-assisted MIE (RAMIE) have increased in prevalence across the world for the management of esophageal cancer. Both minimally invasive modalities have demonstrated decreased morbidity, with preservation of oncologic outcomes, when compared to open esophagectomy. A limitation of conventional MIE is the use of rigid instruments with 2D visualization leading to a prolonged learning curve and extended operative times. RAMIE offers both improved visualization with 3D video capable of magnification and full dexterity with wristed instruments. To date, retrospective and randomized controlled trials demonstrate overall higher harvest during lymphadenectomy by RAMIE compared to MIE, though more studies are needed to determine definitive impact on oncologic outcomes and long-term survival. RAMIE showed superiority for lymphadenectomy after neoadjuvant therapy and for bilateral recurrent laryngeal nerve (RLN) lymphadenectomy with decreased rates of RLN paralysis. Current data suggests no overall cost difference between the two modalities. Ongoing studies will further clarify the role for RAMIE in esophageal adenocarcinoma (EA) and the outcomes of robotic/MIE hybrid techniques.