Abstract Video Descrption The transcervical mediastinoscopic esophagectomy is a relative new technique that has gradually demonstrated because of its ease of dissection along the organ sheath and its less invasive nature. However, the conventional cervical approach to mediastinoscopy has been reported to have a relatively high rate of recurrent nerve palsy due to interference in the mediastinum caused by the straight forceps. To address this, utilizing robotic assistance from a cervical approach for mediastinoscopic esophagectomy may enhance precision, particularly around the RLN. The robot-assisted transcervical esophagectomy (RACE) approach is novel procedure expected to reduce these interferences and improve maneuverability around the recurrent nerve. In this report, we describe a surgical technique and short-term outcome of RACE. At our facility, RACE is primarily performed for patients with a history of thoracic disease or poor performance status, making transthoracic approaches challenging. All RACE cases were conducted using a bilateral cervical approach. The procedure began from the right cervical side, followed by the left. Mediastinal lymph node dissection, including areas around both RLNs, was performed in principle. We analyzed 50 patients underwent RACE. Bilateral cervical RACE was successfully performed in all cases without intraoperative complications. Postoperative complications included RLN palsy in 12.0% (Clavien-Dindo Grade ≥ 1) and pneumonia in 6.0% (Clavien-Dindo Grade ≥ 2). RACE was found to be a relatively safe and feasible procedure. The use of robotic systems also enabled precise mediastinal lymph node dissection, including through a transhiatal approach, highlighting its potential advantages.
Fujita et al. (Fri,) studied this question.