The Evolution of Esophagectomy to Robotic-Assisted Minimally Invasive Esophagectomy (RAMIE) in the Treatment of Esophageal Cancer: Historical Insights and Comparative Outcomes.

Robotic-assisted minimally invasive esophagectomy (RAMIE) has emerged as an increasingly utilized approach for the surgical management of esophageal malignancies, offering potential advantages over conventional minimally invasive esophagectomy (MIE) and open esophagectomy (OE). Advances in robotic technology, enhanced visualization, instrument articulation, and surgeon ergonomics have facilitated wider adoption of RAMIE in thoracic surgical oncology. This review summarizes contemporary evidence regarding intraoperative, postoperative, oncologic, and patient-centered outcomes associated with RAMIE while highlighting emerging technologies and future directions in the field. Current literature, including randomized controlled trials, meta-analyses, propensity-matched studies, and international registry data, suggests that RAMIE is associated with reduced blood loss, improved lymph node harvest, and lower pulmonary morbidity compared with OE, while demonstrating outcomes comparable or favorable to conventional MIE. Oncologic outcomes, including R0 resection rates and overall survival, appear equivalent across approaches in most contemporary studies. In addition, robotic platforms may facilitate recurrent laryngeal nerve lymphadenectomy and complex mediastinal dissection. Despite these advantages, RAMIE is frequently associated with longer operative times and remains dependent on institutional expertise, surgeon experience, and resource availability. Current evidence is promising but remains limited by heterogeneity of surgical techniques, institutional expertise, and a relative scarcity of long-term randomized data. Emerging innovations including fluorescence-guided imaging, perfusion assessment technologies, artificial intelligence integration, augmented reality, and advanced robotic platforms may further enhance precision, safety, and personalization of esophageal cancer surgery. As robotic technology and perioperative systems continue to evolve, ongoing prospective investigation and long-term oncologic evaluation will remain essential to define the optimal role of RAMIE within multidisciplinary esophageal cancer care.