Initial clinical outcomes of uniportal robotic-assisted minimally invasive esophagectomy

Robotic-assisted minimally invasive esophagectomy has improved perioperative outcomes; increased surgical proficiency has promoted interest in uniportal techniques. We aimed to evaluate the perioperative and short-term outcomes of a novel uniportal robotic-assisted minimally invasive esophagectomy performed through an intercostal incision using the da Vinci Xi system. We retrospectively reviewed patients who underwent uniportal robotic-assisted minimally invasive esophagectomy between September 2024 and July 2025. The primary outcome was the complete resection rate with microscopically negative margins (R0). Secondary outcomes included perioperative and short-term outcomes, including operative time, lymph node yield, blood loss, conversion rate, postoperative pain scores, opioid requirements, complication rates, chest tube duration, and hospital stay. Twenty-one patients (median age, 64 years; 86% male) underwent uniportal robotic-assisted minimally invasive esophagectomy. Squamous cell carcinoma was the most common histology (81%); 62% had stage III–IV disease, and 71% received neoadjuvant therapy. The McKeown and Ivor-Lewis procedures were performed in 52% and 48% of cases, respectively; complete resection was achieved in 95%. The median console time, lymph node yield, and blood loss were 155 min, 34, and 450 mL, respectively. One patient (5%) required conversion to thoracoscopic surgery. The postoperative pain scores were consistently low. The median chest tube duration and postoperative hospital stay were 5.5 and 15.0 days, respectively. Clavien–Dindo grade II or higher complications occurred in 29% of the patients, with no 90-day mortality. Uniportal robotic-assisted minimally invasive esophagectomy is safe and feasible, with acceptable perioperative and short-term outcomes in patients with esophageal cancer.