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Robotic thoracic and esophageal surgery: a critical review of comparative outcomes

Robotic technology is the next iteration of minimally invasive surgery (MIS), with theoretical advantages over conventional thoracoscopic and laparoscopic techniques. These include enhanced visualization, improved dexterity, and superior ergonomics, at the expense of increased costs and operative time and loss of haptics. We critically evaluate robotic surgery outcomes in lobectomy, mediastinal surgery, and esophageal surgery both benign and malignant. We demonstrate that while robotics has performed favorably compared to open surgery, it has been difficult to consistently identify superiority in outcomes over VATS/laparoscopy. However, in certain outcomes and situations, robotics has demonstrated an advantage in the literature. This includes decreased length of stay and complication rates in lobectomy, decreased esophageal perforation rates in Heller myotomy, and improved lymphadenectomy in esophagectomy and