A video-based technique for dynamic visualization of peripheral blind zones using a 5-mm sub-scope during robot-assisted esophagectomy

Abstract Background Robot-assisted minimally invasive esophagectomy (RAMIE) has become increasingly prevalent due to its ability to provide a magnified, three-dimensional operative field and articulate instrumentation. However, the narrow and fixed field of view creates peripheral blind zones. Assistant maneuvers and instrument movements frequently occur outside the console view, potentially affecting intraoperative situational awareness and workflow. These factors can lead to inadvertent injuries to adjacent organs such as the aorta, pulmonary vein, trachea, or lungs. This dynamic manuscript illustrates a practical visualization strategy using a 5-mm flexible sub-scope to address blind zones during robot-assisted esophagectomy. Methods This manuscript presents synchronized intraoperative footage from the main robotic camera and a 5-mm flexible sub-scope used during the thoracic phase of RAMIE. Representative operative scenes were selected to demonstrate how the sub-scope provides complementary visualization of areas outside the console field of view. Quantitative assessment of visual coverage was performed in a representative case to illustrate the proportion of assistant activity occurring within and outside the robotic camera view. Additional illustrative scenarios highlight sub-scope utilization during port insertion, instrument exchange, vascular division, and assistant-led background tasks. Results Video analysis demonstrated that a substantial proportion of assistant forceps activity occurred outside the robotic camera’s field of view during the thoracic phase. The sub-scope enabled continuous visualization of these blind zones, allowing assistants to monitor instrument trajectories, surrounding structures, and spatial relationships without requiring repositioning of the main camera. Dynamic intraoperative examples illustrate how this complementary visualization supports safe confirmation during critical steps, facilitates autonomous assistant actions, and enables parallel task execution while preserving uninterrupted console workflow. Conclusions This video-based report demonstrates a practical technique for dynamic visualization of peripheral blind zones during robot-assisted esophagectomy. A 5-mm flexible sub-scope may support intraoperative awareness and coordinated workflow while preserving the stability of the primary console view.