Robot assisted minimally invasive esophagectomy (RAMIE) for esophageal cancer

Worldwide, the standard treatment for locally advanced esophageal cancer with curative intent is perioperative chemotherapy or preoperative chemoradiotherapy followed by open transthoracic esophagectomy (OTE) with gastric conduit reconstruction. Minimally invasive esophagectomy (MIE) was developed to improve the postoperative outcome by reducing the surgical trauma, with comparable short-term oncologic results. However, MIE is a highly complex procedure associated with a long learning curve. In 2003, robot-assisted minimally invasive thoraco-laparoscopic esophagectomy (RAMIE) was developed to overcome the technical limitations of MIE. Robotic surgery benefits from a stable 3-dimensional, magnified view and articulated instruments enabling precise dissection with 7 degrees of freedom of movement. In this review, the development of RAMIE within our hospital is described using a 5-stage development process for the assessment of surgical innovation (IDEAL).