Future Perspectives in Minimally Invasive Upper GI Cancer Surgery

Background
Robot-assisted surgery provides three-dimensional visualization and highly articulated instrument control, enabling precise anatomical dissection that is often challenging with conventional laparoscopy. At our institution, we have adopted a single-port robotic system (da Vinci SP) and the latest-generation platform (da Vinci 5) to perform minimally invasive, high-precision surgery for esophageal cancer, gastric cancer, and esophagogastric junction (EGJ) cancer.
Institutional Approach and Device Characteristics
The single-port system deploys three multi-jointed instruments and a camera through a single incision, providing 360° access. This configuration is particularly advantageous for transhiatal lower mediastinal lymphadenectomy, anastomosis, and mediastinoscopic esophagectomy, enabling stable performance in narrow and complex operative fields and expanding possibilities for novel surgical approaches.
The latest platform offers 10,000-fold greater computational power than previous models and incorporates tactile feedback that generates resistance when excessive force is applied, thereby helping to prevent inadvertent organ injury. Furthermore, both instrument motion and tactile data can be digitally recorded and analyzed, facilitating objective assessment, standardization of surgical techniques, and paving the way for automation and AI-assisted surgery using EUREKA™.
Surgical Concept
Our core principle is to accurately identify the fascia between the resected and preserved organs and to follow the correct dissection plane. Fascia consists of elastin, collagen, blood vessels, and lymphatic vessels. While blood and lymphatic vessels require sealing before transection, fibrous tissue composed of elastin and collagen can be smoothly divided using cold-cut techniques. This approach improves visualization and procedural efficiency and is applicable even in fibrotic tissue after chemotherapy. Integration of AI-based recognition systems enables real-time identification of fascia, vessels, and nerves, further enhancing surgical safety and precision.
Conclusion
State-of-the-art robot-assisted techniques enable safe and precise manipulation in narrow and complex anatomical spaces, contributing to less invasive and higher-quality surgery for esophageal, gastric, and EGJ cancers. Digital recording and analysis of surgical motion and tactile information will promote the visualization and standardization of surgical skills, representing a key step toward realizing next-generation robotic surgery in combination with AI technology.