Upper Gastrointestinal Surgery: Robotic Surgery versus Laparoscopic Procedures for Esophageal Malignancy

Abstract

Background: The evolution of minimally invasive surgery (MIS) also extends to the field of esophageal surgery and has brought forth the development of several approaches of minimally invasive esophagectomy (MIE). Hybrid and total minimally invasive operative techniques have proven beneficial compared to open surgery and are currently evaluated against robotic-assisted minimally invasive esophagectomy (RAMIE). We aim to review the current literature regarding the position of MIE versus RAMIE. Methods: A systematic review of the relevant literature on minimally invasive esophageal surgery for cancer is presented. A PubMed search was carried out for the period of 1992-2018 with the following search terms: 'esophageal cancer', 'minimally invasive surgery', 'resection', 'transhiatal', 'transthoracic', 'MIE', 'hybrid', 'robotic resection', 'RAMIE', 'RATE'. Results: Hybrid and total minimally invasive operative techniques have proven beneficial, especially with regard to pulmonary complications, compared to open surgery. Oncologic outcomes appear equivalent between open and minimally invasive techniques. Currently, the position of RAMIE is being evaluated against other minimally invasive techniques. Conclusion: All minimally invasive techniques confer the expected reduction in perioperative morbidity compared to open surgery. However, MIS is still evolving with regard to specific technical challenges, especially anastomotic techniques.