Since the introduction of robotic systems in esophageal surgery in 2000, the number of robotic
esophagectomies has been gradually increasing worldwide, although
robot-assisted surgery is not yet regarded as standard treatment for
esophageal cancer, because of its high cost and the paucity of high-level evidence. In 2016, more than 1800 cases were operated with robot assistance. Early results with small series demonstrated feasibility and safety in both robotic transhiatal (THE) and transthoracic
esophagectomies (TTE). Some studies report that the learning curve is approximately 20 cases. Following the initial series, operative results of robotic TTE have shown a tendency to improve, and oncological long-term results are reported to be effective and acceptable: R0 resection approaches 95%, and locoregional recurrence is rare. Several recent studies have demonstrated advantages of robotic
esophagectomy in
lymphadenectomy compared with the thoracoscopic approach. Such technical innovations as three-dimensional view, articulated instruments with seven degrees of movement,
tremor filter etc. have the potential to outperform any conventional procedures. With the aim of preventing postoperative pulmonary complications without diminishing
lymphadenectomy performance, a nontransthoracic radical
esophagectomy procedure combining a video-assisted cervical approach for the upper mediastinum and a robot-assisted transhiatal approach for the middle and lower mediastinum, transmediastinal
esophagectomy, was developed; its short-term outcomes are promising. Thus, the merits or demerits of robotic surgery in this field remain quite difficult to assess. However, in the near future, the merits will definitely outweigh the demerits because the esophagus is an ideal organ for a robotic approach.