title: Robotic-assisted thoracoscopic surgery (RATS) for benign and malignant esophageal tumors.
abstract: BACKGROUND
  Robotic surgical systems are most effective for operations in areas that are small and difficult to reach. Ideal indications for this new technology have yet to be established. The esophagus possesses attributes that are interesting for general thoracic robotic surgeons.
  
  
  METHODS
  Robotic-assisted thoracoscopic surgery (RATS) using the da Vinci system (Intuitive Surgical, Inc, Mountain View, CA) was performed in six patients with esophageal tumors. This comprised the dissection of the intrathoracic esophagus including lymph node dissection in four patients suffering from esophageal cancer and the extirpation of a benign lesion (one leiomyoma and one foregut cyst) in the remaining two patients.
  
  
  RESULTS
  All procedures were completed successfully with the robot. The median overall operating time was 173 (160-190) minutes in the oncologic cases and 121 minutes in the benign cases, including the robotic act of 147 (135-160) minutes and 94 minutes, respectively. There were no intraoperative complications. One patient had to undergo a redo thoracoscopy because of a persistent lymph fistula. One cancer patient died after 12 months due to tumor progression and another patient had to be stented due to local tumor recurrence 19 months postoperatively.
  
  
  CONCLUSIONS
  This first small series of various esophageal pathologies treated by robotic-assisted thoracoscopic surgery supports the impression that the esophagus is an ideal organ for a robotic approach. The potential of the da Vinci system, especially for oncologic indications, remains to be proven in future clinical trials.
authors.affiliation: Department of General and Transplant Surgery, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Bodner
authors.forename: Matthias
authors.initials: M
authors.lastname: Zitt
authors.forename: Harald
authors.initials: H
authors.lastname: Ott
authors.forename: Gerold J
authors.initials: GJ
authors.lastname: Wetscher
authors.forename: Heinz
authors.initials: H
authors.lastname: Wykypiel
authors.forename: Paolo
authors.initials: P
authors.lastname: Lucciarini
authors.forename: Thomas
authors.initials: T
authors.lastname: Schmid
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D004934:Esophageal Cyst / Q000601:surgery; D004938:Esophageal Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007889:Leiomyoma / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012371:Robotics / Q000295:instrumentation / Q000379:methods; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome