{"doi":"10.1093/dote/doaa110","title":"Robotic equipment: what do we need for a robotic-assisted minimally invasive esophagectomy (RAMIE)?","abstract":"Surgical resection is the cornerstone for local control and long-term survival of patients with locally advanced esophageal cancer treated by multimodality therapy. The evolution of minimally invasive esophagectomy (MIE) to include telerobotics has contributed to expanding the capabilities of performing this complex operation through minimally invasive techniques. Robotic surgery enhances several key aspects of minimally invasive surgery, such as enhanced vision, stable view, and highest precision due to articulated instrumentation and scaling of motion.1 Cohort studies have shown that robot-assisted minimally invasive esophagectomy (RAMIE) is feasible and safe.2 Robotic movements are intuitive where the instrument tips move in the same direction as the surgeon’s hands. It allows for a greater range of motion and precision that is not seen with laparoscopic instruments. Herein, we describe our positioning, port placement, and instruments used during a transthoracic (Ivor Lewis type) RAMIE. Robotic platform: daVinci Xi Robotic Surgical System with 30-degree camera system and fluorescence imaging (Firefly, Intuitive Surgical, Sunnyvale, CA, USA). Robotic supplies/instrumentation: Three 8-mm trocars and one 12-mm robotic stapling trocar with insufflation caps Instruments: Fenestrated bipolar forceps, permanent cautery spatula, tip-up fenestrated grasper, robotic vessel sealer, large Hem-o-lok clip applier, large mega needle driver, endowrist Stapler 30-mm curved-tip, endowrist stapler 45-mm curved tip Nonrobotic supplies/instrumentation: CO2 insufflation and tubing Laparoscopic suction irrigator (5 mm) ¼” Penrose drain Nathanson liver retractor Endostitch Suturing Device (Medtronic) Wound protector The operating room arrangement should allow for the daVinci robot to have space to be moved toward the operating table. The daVinci Xi robot can be docked from either side of the operating table for both the abdominal and thoracic portion of the procedure. We prefer docking from the left for both portions of the procedure. The final room layout should support all participants of the procedure (Fig. 1). Room layout. The daVinci Xi robot is docked from the left. The surgical table and robotic cart are arranged on the opposite side of the robot to allow for space to maneuver the robot as it approaches the table. The configuration remains the same during both phases of surgery, although the assistant stands on the right side of the patient during abdominal portion and to the left side during the chest phase. The patient is placed in the supine position. Both arms are padded and tucked at the patient’s sides, and a footboard is placed for support during reverse Trendelenburg positioning (Fig. 2a). Esophagogastroscopy is performed in every case by the operating surgeons to assess the status of the esophagus with respect to location of the tumor, response to preoperative treatment (if applicable), and any concurrent esophageal or gastric conditions. The suitability of the stomach to serve as the conduit for reconstruction is also evaluated. (a) Abdominal positioning. Patient is supine with arms tucked. Incisions are marked out for the placement of the robotics arms. (b) Thoracic positioning. Patient is placed in the left lateral decubitus position, slightly tilted anterior. Incisions marked for port placements. Following completion of the abdominal phase, the patient is placed in a left lateral decubitus position and tilted slightly prone. The patient is placed with the midthorax positioned over the break, and the table is flexed in order to maximally separate the rib spaces. A beanbag is used to stabilize the patient, and the up arm is placed in 90-degree abduction and flexion at the elbow. (Fig. 2b). A Veress needle is used in the left upper quadrant (LUQ) to insufflate the abdomen. Once insufflated to a pressure of 15 mm Hg, a midline robotic 8-mm port above the level of the umbilicus is placed. Two other 8-mm ports are then placed at the ","journal":"Diseases of the Esophagus","year":2020,"id":131752,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.957,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":417848,"name":"Bernard J. Park","orcid":"0000-0003-3814-5144","position":1,"is_corresponding":false},{"id":253865,"name":"Daniela Molena","orcid":"0000-0003-1655-4473","position":2,"is_corresponding":false},{"id":585950,"name":"Daniel Mansour","orcid":"0009-0004-0518-0407","position":0,"is_corresponding":true}],"reference_count":5,"raw_metadata":null,"created_at":"2026-07-18T23:16:03.875886Z","pmid":"33241310","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}