Robotic-assisted Minimally Invasive Oesophagectomy using the Versius System: Initial Experience and Short Term Outcomes from a Tertiary Oesophagogastric Cancer Centre

Background Oesophagectomy is the gold standard treatment for patients with early or locally advanced oesophageal cancer. Minimally invasive approaches are associated with reduced perioperative morbidity and mortality, and whilst such methods have traditionally employed a combination of laparoscopic and thoracoscopic approaches, the use of the robot has additionally conferred a greater degree of dexterity and precision for the operating surgeon. The Versius(R) system (CMR Surgical) has a modular design comprising individual arms which offers flexibility with patient positioning. Despite its uptake, the feasibility and safety of the Versius system with minimially invasive oesophagectomy has not been characterised. Methods We performed a retrospective review of patients operated with curative intent for oesophageal cancer between October 2021 and March 2023. Patients who underwent robotic-assisted oesophagectomy were included in the study, including hybrid and fully robotic approaches. Data pertaining to short term post-operative and oncologic outcomes was obtained and analysed. Results Seventeen robotic-assisted oesophagectomies were performed. Sixteen (94.1%) underwent a hybrid approach; eight (47.1%) with laparoscopic abdomen and robotic thoracic phases, and the remainder with robotic abdomen and open thoracic phases. One (5.9%) underwent fully robotic abdominal and thoracic oesophagectomy. There were four (23.5%) unplanned conversions to thoracoscopic or laparoscopic surgery. The median operating time was 454 minutes, and length of stay was 11 days. Five patients suffered a major (Clavian-Dindo >III) compllication. There were no deaths within 90-days of sugery. The median lymph node harvest was 23.5 nodes, and a microscopically margin-negative (R0) resection was achieved in 87.5% of cases. Conclusions Our experience with the CMR Versius System is that of safety and feasibility, and suitability for both the abdominal and thoracic phase of minimially invasive oesophagectomy. Further studies are warranted to assess longer-term oncologic and survival outcomes.