Esophageal cancer surgery robotic esophagectomy in the prone position

Esophagectomy with total mediastinal lymphadenectomy with or without cervical lymphadenectomy remains the main option for the curative treatment of esophageal squamous cell carcinoma. However, meticulous mediastinal lymph node dissection frequently induces recurrent laryngeal nerve palsy (RLNP), leading to postoperative laryngopharyngeal dysfunction. Surgical robots have been developed to overcome some of the disadvantages of standard minimally invasive surgery and facilitate precise dissection in a confined surgical field with impressive dexterity. We have been using the surgical robot, da Vinci S HD Surgical System, in the thoracic phase of esophagectomy since 2009. To date, we have performed approximately 30 cases of robotic esophagectomy and have demonstrated the possibility that the use of the robotic system in thoracoscopic esophagectomy in the prone position might reduce postoperative laryngopharyngeal dysfunction related to RLNP. In this chapter, we present updates on the methods and short-term outcomes of robotic esophagectomy based on our experience and review of the literatures.