Current Status and Future Prospects of Robot-Assisted Esophageal Cancer Surgery Training in Our Hospital

Background In Japan, robot-assisted surgery (RAS) for esophageal cancer has been covered by insurance for over six years. RAS has increased in specialized cancer hospitals such as university hospitals, cancer centers, and general hospitals like ours. This trend is expected to continue with the relaxation of regulations regarding surgeons for RAS. When considering the training of the next generation surgeons in the field of esophageal surgery, which involves critical organs such as the heart, lungs, and large blood vessels and requires precise lymph node dissection techniques, a challenge arises: whether to start the training with RAS or thoracoscopic surgery (TS). Methods Generally, the training sequence follows scopistb→assistant→surgeon. However, RAS has a strong aspect of solo surgery, which might diminish the involvement and awareness of assistants. Consequently, starting surgical training with RAS might make it difficult to handle specific situations, such as the unique thoracic surgical field deployment and traction force adjustment. Experience in TS is considered beneficial in these scenarios. Results In our hospital, the next-generation surgeon has begun training in TS and RAS, having accumulated experience with 33 cases (TS: 22 cases, RAS: 11 cases) in the past year and a half. The median thoracic operation time was 220 min in TS: 252 min in RAS, and the incidence of recurrent laryngeal nerve paralysis was 2 (9.1%) cases in TS: 0 (0%) case RAS, comparable to the results of supervising surgeons. Conclusion Implementing standardized TS concepts based on detailed anatomy into RAS ensures that the procedures do not differ significantly, maintaining quality. Standardization of surgical techniques facilitates esophageal cancer surgery training even in general community hospitals, and training with a double standard of TS and RAS is considered more effective.