Hybrid versus Total Robot-Assisted Esophagectomy in the Single-Port Era

Background: Single-port (SP) subcostal robot-assisted minimally invasive esophagectomy minimizes thoracic access trauma.However, performing a fully robotic SP abdominal phase remains challenging due to the lack of commercially available SP-compatible staplers and advanced energy devices.Consequently, a hybrid approach combining SP thoracic resection with conventional laparoscopic gastric mobilization ("hybrid-SP") is currently preferred.Alternative methods include fully robotic multiport esophagectomy ("total-MP") and a 2-robot strategy ("dual-robot").Although a purely SP procedure ("total-SP") is technically feasible, it significantly increases procedural complexity and duration without clear clinical benefit.Methods: We systematically compared hybrid-SP, total-MP, and dual-robot approaches with respect to operative workflow, procedural cost-effectiveness, and short-term clinical outcomes.Results: All evaluated procedures fulfilled feasibility criteria.The total-MP approach provided the most streamlined workflow and lowest disposable costs; however, multiple thoracic incisions potentially increased postoperative pain and pulmonary morbidity compared to hybrid-SP.The hybrid-SP demonstrated comparable operative durations and costs to total-MP while notably reducing thoracic trauma, necessitating laparoscopic abdominal mobilization as a practical compromise.The dual-robot approach substantially increased operative duration and costs without measurable clinical advantages.Conclusion: Until SP-specific stapling and vessel-sealing devices become available, performing the abdominal phase laparoscopically remains preferable to fully SP or dual-robot techniques.The anticipated introduction of comprehensive SP instrumentation may shift future practice toward fully robotic SP esophagectomy.