The evolution of anastomotic techniques in robot-assisted Ivor Lewis esophagectomy

Radical esophagectomy is the cornerstone in the treatment of esophageal cancer combined with perioperative therapies, whereas patients diagnosed at an early stage may be candidates for endoscopic resection. Minimally invasive procedures aim to improve the postoperative complications and reduce overall morbidity. The short and long-term results of the incorporation of robot-assisted esophagectomy in specialised centres worldwide have been encouraging. The Ivor Lewis technique has become the preferable approach, reaching up to 61% of the minimally invasive reconstructions in the Western World; however, the percentage of anastomotic leaks remains problematic. Throughout the last decade, a few modifications of the anastomotic technique have been proposed in an effort to improve the surgical results of the robot-assisted approach. This review presents the evolving robotic techniques of performing the esophagogastric anastomosis. An overview of the available approaches will be discussed with a focus on the intrathoracic anastomosis.