Robotic Assisted Esophageal Surgery:

As a pliable muscular tube that spans three body compartments in close proximity to the great vessels, the esophagus and its anatomic design impart formidable challenges for the surgeon. Operative approaches are made more difficult by secondary physiologic insult inherent in prolonged operations that transverse both sides of the diaphragm.

Pulmonary complications historically provide impetus for evolving surgical approaches to the esophagus. Technological developments allowing ventilation during a thoracotomy only permitted successful resection and anastomosis seventy years ago. The postoperative complications of atelectasis and decreased tidal volume secondary to a thoracotomy spurned the development of transhiatal open approaches as well as various minimally invasive methods. Surgical approaches to the treatment of benign esophageal pathology rely on an implicit yet symbiotic relationship between surgical technique and technological development.

Minimally invasive techniques limit the mechanical and physiologic stress of their open predecessors. Decreased hospital stay, rapid recovery and decreased perioperative morbidity are positive outcomes that are shared by both laparoscopy and video-assisted thoracoscopic surgery. These minimally invasive approaches spare the patient the debilitating pulmonary effects of a thoracotomy at the cost of increased technical difficulty for an operation already in a precarious anatomic location. Robotic master-slave devices are the newest tools in the surgeons armamentarium. With equivalent port size used in other minimally invasive techniques, these machines promise the operator improved three-dimensional spatial accuracy and increased precision. Esophageal robotics seems ideal when evaluated in a historical context. The minimally invasive approach spares the patient a thoracotomy while precision instrumentation facilitates dissection and anastomosis.