Robot-Assisted Minimally Invasive Esophagectomy Using the Single-Port Robotic System via the Subcostal Approach: A Single-Center Retrospective Study

Background: Robot-assisted minimally invasive esophagectomy (RAMIE) has gained global popularity.Two recent randomized controlled trials demonstrated that RAMIE leads to shorter operative times and a greater number of dissected lymph nodes than conventional minimally invasive esophagectomy (MIE).This study presents initial experience with single-port RAMIE (SRAMIE) performed via the subcostal approach using the single-port (SP) robotic system.The study aimed to assess the feasibility and perioperative outcomes of SRAMIE compared with multiport RAMIE (MRAMIE) using the Xi robotic system and video-assisted thoracic surgery esophagectomy (VAE).Methods: This retrospective study included patients who underwent MIE for esophageal cancer at Korea University Guro Hospital between February 2017 and December 2024.Patients were divided into 3 groups: SRAMIE (n=17), MRA-MIE (n=13), and VAE (n=23).The primary outcome was the incidence of postoperative complications.Secondary outcomes included chest tube duration, length of postoperative hospital stay, postoperative pain, and 30-day mortality.Results: No conversions to thoracotomy or VAE occurred in the SRAMIE group.Compared with VAE, SRAMIE resulted in significantly shorter chest tube duration (p=0.038),shorter postoperative hospital stays (p=0.036), and lower peak postoperative pain (p=0.003).No significant differences were observed among the 3 groups regarding total operative time, the number of resected lymph nodes, or the incidence of postoperative complications.Conclusion: SRAMIE using the SP robotic system is a feasible approach offering advantages over VAE in recovery and postoperative pain.The noninferior perioperative outcomes indicate that SRAMIE may serve as a viable alternative to conventional MIE, warranting further large-scale studies.