title: Robotic-assisted transhiatal esophagectomy.
abstract: BACKGROUND
  Despite its reduced aggressiveness and excellent results obtained in certain diseases, minimally invasive surgery did not manage to significantly lower the risks of esophageal resections. Further advances in technology led to the creation of robotic systems with their unique maneuverability of the instruments and exceptional view on the operative field, thus setting the prerequisites for performance in complex surgical procedures and offering new possibilities to a disease notorious for its dismal prognosis.
  
  
  METHODS
  The robotic-assisted transhiatal esophagectomy technique was used in a patient with squamous cell carcinoma of the lower esophagus that had high medical risk for surgical therapy.
  
  
  RESULTS
  Esophageal resection and reconstruction were possible through a robotic-assisted minimally invasive transhiatal approach. There were no intraoperative incidents, blood loss was minimal, and lymph node dissection and removal was possible during the procedure. Early ambulation and conservative treatment of the mild complications that occurred offered a favorable postoperative outcome.
  
  
  CONCLUSIONS
  The robotic-assisted transhiatal esophagectomy technique is feasible and safe. Complex procedures become less technically demanding with the help of the robotic system and, thus, the minimally invasive approach can be offered for the benefit of selected patients. Further studies are required to confirm these observations and to establish the role of this procedure in the future.
authors.affiliation: Department of General, Visceral, and Trauma Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. gutt@med.uni-heidelberg.de
authors.forename: Carsten N
authors.initials: CN
authors.lastname: Gutt
authors.forename: Vasile V
authors.initials: VV
authors.lastname: Bintintan
authors.forename: Jörg
authors.initials: J
authors.lastname: Köninger
authors.forename: Beat P
authors.initials: BP
authors.lastname: Müller-Stich
authors.forename: Michael
authors.initials: M
authors.lastname: Reiter
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D004434:Early Ambulation; D004867:Equipment Design; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000295:instrumentation*; D005240:Feasibility Studies; D006305:Health Status Indicators; D006801:Humans; D008197:Lymph Node Excision / Q000295:instrumentation; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology; D012371:Robotics / Q000295:instrumentation*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D013523:Surgical Equipment; D013673:Technology Assessment, Biomedical