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INNOSC Theranostics and
Pharmacological Sciences Robotics in modern surgery and critical operations

of improving surgical outcomes by reducing discomfort or “robotic-assisted,” “esophagectomy,” and “esophageal
and accelerating recovery. A pooled analysis of 14 studies cancer.” In esophageal surgery, the robot can be utilized
with 7,438 patients found that RATS is an effective and in various ways. Overall, complications from RAMIE
safe alternative to video-assisted thoracic surgery, resulting are comparable to those from open esophagectomy and
in lower 30-day mortality and conversion rates. One traditional thoracoscopic MIE, with some evidence
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type of robotic thoracic surgery is pure uniportal-RATS suggesting lower rates of complications. RAMIE may help
(U-RATS), which is performed through a single intercostal reduce pulmonary complications, according to several
incision without rib spreading, using a robotic camera, meta-analyses, although two randomized controlled studies
dissecting tools, and staplers. U-RATS offers advantages showed similar incidences of these issues. Notably, RAMIE
such as easier management of potential intraoperative may facilitate the dissection of lymph nodes, particularly
bleeding compared to multiport approaches, due to its in the region of the left recurrent laryngeal nerve. In
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quick undocking and the surgeon’s required experience addition, 10 cases of bilateral transcervical esophagectomy
with the uniportal technique. U-RATS provides a potential with robotic assistance performed at the National Cancer
solution for lung resections that is both comfortable Center Hospital East in Japan between February and August
for surgeons and promotes rapid recovery for patients. of 2023 were examined. The study assessed the viability
Additional benefits of RATS include 3D visualization and effectiveness of the procedure, along with short-term
and maneuverability. While current robotic systems surgical outcomes. The results demonstrated the safety
are designed for multiport surgery (3 – 5 incisions), a and feasibility of robot-assisted bilateral transcervical
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modification of the Davinci Xi system has been developed esophagectomy for thoracic esophageal cancer. This
®
specifically for the U-RATS technique. This adaptation procedure is expected to reduce the incidence of recurrent
allowed the execution of the world’s first pure robotic cases nerve palsy, a condition associated with mediastinoscopic
in September 2021 in Spain. Since then, over 100 anatomic esophagectomy and transcervical esophagectomy.
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resections, including carinal resections, sleeve resections, RAMIE has also been linked to significantly lower rates of
multiple sleeve resections, and all segmentectomies, have wound infections (odds ratio [OR]: 0.20, 95% confidence
been performed using this approach. 21 interval [CI]: 0.07 − 0.57), atrial fibrillation (OR: 0.53, 95%
CI: 0.29 − 0.98), pneumonia (OR: 0.39, 95% CI: 0.26 −
2.5. Robotic-assisted thoracic esophagectomy 0.57), and overall pulmonary complications (OR: 0.38, 95%
Esophageal cancer is ranked as the eighth most prevalent CI: 0.26 − 0.56). It also results in less blood loss (weighted
cancer globally and the sixth leading cause of cancer-related mean difference [WMD]: −187.08 mL, 95% CI: −283.81
deaths by the World Health Organization. Minimally − −90.35), shorter hospital stays (WMD: −9.22 days, 95%
invasive esophagectomy (MIE) was first performed in CI: −14.39 − −4.06), but longer operative times (WMD:
the early 1990s, followed by the introduction of robotic- 69.45 min, 95% CI: 34.39−104.42). No other statistically
assisted procedures after the turn of the millennium. Over significant differences in short-term oncological and
the past 15 years, the development of robotic-assisted surgical outcomes were observed. Comparisons between
MIE (RAMIE) has been facilitated by advancements in entirely robotic operations and open esophagectomy
robotic platforms. While recent evidence suggests that also yielded similar results. Overall, RAMIE is a safe
RAMIE reduces post-operative morbidity and improves and effective procedure that reduces blood loss, wound
quality of life compared to open esophagectomy, no infections, cardiopulmonary morbidity, and hospital stays
randomized trials have directly compared RAMIE with compared to open esophagectomy. 24
standard MIE. At our hospital, the hybrid robotic-assisted
thoracoscopic procedure has demonstrated that there is 2.6. Robotic-assisted neurosurgery
a lower bar for patients to meet before they can undergo In the mid-1980s, surgeons began using the first robotic
surgery. When comparing robotic-assisted esophagectomy device for performing precise biopsies in neurosurgery.
to open esophagectomy, there were no statistically Initially, robotic surgery was used predominantly in
significant differences in post-operative complications neurosurgery but has since spread to other fields such
or early oncological outcomes. Therefore, we believe that as urology, gynecology, gastrointestinal surgery, and
both methods are safe and effective. The use of RAMIE orthopedics. The use of robotic devices in neurosurgery
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for esophageal cancer has rapidly expanded globally, and offers the potential to improve surgical precision and
this narrative review aims to clarify the current state and enable more complex procedures for neurosurgeons.
potential future directions of RAMIE. References were A retrospective review of 41 patients who underwent
gathered from PubMed and Embase for papers published robotic-assisted frameless brain biopsies using the
up until April 8, 2023, using search terms “robot,” “robotic,” SurgiScope system demonstrated the safety, feasibility,

Volume 8 Issue 3 (2025) 15 doi: 10.36922/itps.4664