Initial experiences of the transthoracic esophagectomy for esophageal cancer via intercostal approach with the single-port robotic surgical system

초록

BackgroundThe robotic single-port surgical system (SPS) presents several potential advantages over conventional multiport (MP) robotic systems; however, its feasibility in esophageal cancer surgery remains unclear. This study compared the outcomes of transthoracic robotic SPS esophagectomy via an intercostal approach with conventional robotic-assisted minimally invasive esophagectomy (RAMIE).MethodsBetween December 2024 and November 2025, 104 cases of MP RAMIE and 21 cases of transthoracic robotic esophagectomy via an intercostal approach using the SPS for esophageal cancer were compared.ResultsBaseline demographics were comparable between groups. Although clinical stage distribution did not differ significantly, patients in the SPS group more frequently had earlier-stage disease. Neoadjuvant therapy was more commonly administered in the MP group. Operative outcomes were comparable between the two approaches. Total operation time and robotic console time did not differ significantly. Estimated blood loss was significantly lower in the SPS group. The number of dissected lymph nodes (LNs), including bilateral recurrent laryngeal nerve LN, and R0 resection rates were similar. Postoperative hospital stay and peak pain scores during admission were also comparable. Major postoperative complications (Clavien-Dindo grade >= III) occurred in 34.4% of patients, with no significant difference between groups. Postoperative vocal cord palsy occurred less frequently in the SPS group. One postoperative death occurred in the SPS group due to acute myocardial infarction, which was considered unrelated to the surgical procedure.ConclusionsTransthoracic robotic SPS esophagectomy via the intercostal approach was feasible and safe, and enabled sufficient upper mediastinal lymph node dissection compared to MP RAMIE.

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