# Da Vinci single-port-assisted subcostal esophagectomy (SP SC RAMIE) – a promising SP approach

## TL;DR

A new single-port robotic surgery method for esophageal cancer shows promise with low complications and quick recovery.

## Contribution

Introduces and evaluates a novel single-port robotic-assisted esophagectomy technique with promising clinical outcomes.

## Key findings

- All 25 cases achieved R0 resection with a mean lymph node yield of 30.
- Postoperative complications were low (8% pneumonia, 8% anastomotic leakage), with no mortality.
- Patients had rapid recovery, low pain scores, and a median hospital stay of seven days.

## Abstract

Single-port subcostal robotic-assisted minimally invasive Ivor Lewis esophagectomy (SP SC RAMIE) offers advantages in esophageal cancer surgery but remains unfamiliar and requires a long learning curve. This retrospective case series study evaluates its feasibility, safety, and short-term outcomes.

The first 25 consecutive SP SC RAMIE procedures were analyzed. Patient demographics, neoadjuvant therapy, resection margins, lymph node yield, intraoperative parameters, postoperative recovery, complications, and mortality were assessed. Feasibility was defined by achieving R0 resection and a lymph node yield exceeding benchmark recommendations.

The cohort consisted primarily of male patients with adenocarcinoma of the esophagogastric junction, 72% of whom had undergone neoadjuvant therapy. R0 resection was achieved in all cases, with a mean lymph node yield of 30 (SD ± 10), confirming procedural feasibility. Mean total operative time was 324 (± 51) minutes, with an active console time of 79 (± 17) minutes. No intraoperative complications or conversions occurred. No patient received epidural or intercostal catheter analgesia and mean postoperative pain scores were very low. By postoperative day five, 92% of patients were receiving analgesia on demand. Most patients ambulated on the first postoperative day, and the median hospital stay was seven days (range 5–40). Postoperative complications included two cases of pneumonia (8%) and two anastomotic leakages (8%), all managed endoscopically with an endoluminal vacuum sponge. In-hospital, 30-day, and 90-day mortality rates were 0%.

SP SC RAMIE is a feasible and safe esophagectomy technique for lower esophageal cancer resection, with a low complication rate and high lymph node retrieval. Rapid recovery, low pain scores, and a short hospital stay highlight its potential benefits.

The online version contains supplementary material available at 10.1007/s00464-025-12383-z.