Initial clinical outcomes of uniportal robotic-assisted minimally invasive esophagectomy.

BACKGROUND

Robotic-assisted minimally invasive esophagectomy has improved perioperative outcomes; increased surgical proficiency has promoted interest in uniportal techniques. We aimed to evaluate the perioperative and short-term outcomes of a novel uniportal robotic-assisted minimally invasive esophagectomy performed through an intercostal incision using the da Vinci Xi system.

METHODS

We retrospectively reviewed patients who underwent uniportal robotic-assisted minimally invasive esophagectomy between September 2024 and July 2025. The primary outcome was the complete resection rate with microscopically negative margins (R0). Secondary outcomes included perioperative and short-term outcomes, including operative time, lymph node yield, blood loss, conversion rate, postoperative pain scores, opioid requirements, complication rates, chest tube duration, and hospital stay.

RESULTS

Twenty-one patients (median age, 64 years; 86% male) underwent uniportal robotic-assisted minimally invasive esophagectomy. Squamous cell carcinoma was the most common histology (81%); 62% had stage III-IV disease, and 71% received neoadjuvant therapy. The McKeown and Ivor-Lewis procedures were performed in 52% and 48% of cases, respectively; complete resection was achieved in 95%. The median console time, lymph node yield, and blood loss were 155 min, 34, and 450 mL, respectively. One patient (5%) required conversion to thoracoscopic surgery. The postoperative pain scores were consistently low. The median chest tube duration and postoperative hospital stay were 5.5 and 15.0 days, respectively. Clavien-Dindo grade II or higher complications occurred in 29% of the patients, with no 90-day mortality.

CONCLUSION

Uniportal robotic-assisted minimally invasive esophagectomy is safe and feasible, with acceptable perioperative and short-term outcomes in patients with esophageal cancer.