# Total Robot-Assisted Minimally Invasive Esophagectomy for De Novo Esophageal Cancer after Liver Transplantation: The Potential of Robotic Surgery in a Complex Posttransplant Case

## TL;DR

Robotic surgery successfully treated esophageal cancer in a patient after liver transplantation, showing it can safely handle complex posttransplant cases.

## Contribution

Demonstrates the feasibility and safety of total RAMIE for de novo esophageal cancer after liver transplantation.

## Key findings

- Total RAMIE was performed without damaging vital organs despite extensive adhesions.
- The patient was discharged without postoperative complications.
- Robotic precision expands options for complex posttransplant surgeries.

## Abstract

The malignancy risk has increased following improvements in the long-term survival rates after liver transplantation. Reports show a 23.4-fold increase in the risk of de novo esophageal cancer after liver transplantation compared to the general population. We report the case of a 47-year-old female diagnosed with early esophageal cancer after liver transplantation. Endoscopic submucosal dissection was performed; however, due to it being a noncurative resection, additional treatment was required. Total robot-assisted minimally invasive esophagectomy (RAMIE) was performed using a robot for thoracic and abdominal procedures. Although extensive adhesions were observed after liver transplantation, precise surgery using the robot did not damage any vital organs, such as the graft blood vessels. The patient was discharged without postoperative complications. Total RAMIE for esophageal cancer after liver transplantation is a feasible and safe option following careful evaluation of the patient’s condition, and expands the possibilities of successful complex posttransplant surgeries through robotic precision.