First in New Zealand: Total Robotic Oesophagectomy

We report the first totally robotic oesophagectomy performed in New Zealand, representing a significant advancement in robotic upper gastrointestinal surgery. The procedure was completed entirely robotically without adjunctive thoracoscopic or laparoscopic components, in contrast to most international series, which remain hybrid [1]. A fully robotic Ivor Lewis oesophagectomy with two-field lymphadenectomy offers particular advantages in complex cases requiring precise dissection [2]. A 76-year-old man with lower oesophageal/gastro-oesophageal junction adenocarcinoma underwent staging PET demonstrating FDG-avid primary disease with left gastric nodal involvement and no distant metastases. Following neoadjuvant FLOT chemotherapy with atezolizumab, he achieved a partial metabolic response. His history included prior laparotomy with left hemicolectomy, treated leukaemia and prostate cancer. A totally robotic Ivor Lewis oesophagectomy was performed. The abdominal phase required extensive adhesiolysis, gastric mobilisation, conduit formation and D2 lymphadenectomy. Robotic articulation enabled safe dissection of a bulky (> 2 cm) left gastric node from the left gastric and splenic vessels. The thoracic phase included oesophageal mobilisation, azygos division, mediastinal lymphadenectomy and stapled intrathoracic anastomosis with omental wrap. Recovery was largely uncomplicated. Contrast study showed no leak, and the patient was discharged on postoperative day eight. Histopathology demonstrated R0 resection with one of 33 nodes positive (ypT3 pN1). This case builds on our prior minimally invasive (thoracoscopic and laparoscopic) experience and demonstrates the feasibility of a fully robotic programme [3]. The robotic platform enhances visualisation, precision and ergonomics, facilitating complex lymphadenectomy and reconstruction, particularly in patients with prior surgery or bulky nodal disease. Implementation followed a structured, stepwise pathway with benchmarking and progression from laparoscopic to robotic phases. In lower-volume settings such as New Zealand, careful programme development, multidisciplinary support and outcome audit are essential [4, 5]. Ongoing evaluation is required to validate outcomes and guide wider adoption. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.