Endoscopic Robotic Esophagectomy Historical Background “The history of esophageal surgery is a tale of men repeatedly losing to a stronger adversary yet persisting in this unequal struggle until the nature of the problems became apparent and the war was won.” A discussion on robotic esophagectomy is appropriately prefaced by this quote by Emslie, which provides the most accurate perspective for the struggle of surgeons with this elusive organ (1). The anatomic remoteness of the esophagus, along with the many challenges of intraoperative management, have dictated the approach to esophagectomy through the ages. Galen described the patient with esophageal cancer in the second century AD. In the tenth century, Avicenna described esophageal tumors as the most common cause of dysphagia (2). Although surgery of the esophagus was first recorded by the Egyptians in 2500 BC with “repair of the gullet,” the first successful resection of cervical esophageal cancer was performed by Czerny in 1877 (3). This work was predicated on Billroth's work in 1871 who demonstrated the feasibility of resection and re-anastomosis of the cervical esophagus in an animal model (4). However, it was six decades later that a successful esophageal resection with intrathoracic anastomosis was performed (5). In 1913, Torek performed the resection of a squamous cell carcinoma (SCCA) of the thoracic esophagus through the left chest (6). Esophageal gastric continuity was established using a rubber tube that connected the cervical esophagus to the stomach. The patient survived 13 years. For the first decades of the twentieth century, many techniques for the establishment of continuity of the alimentary tract were investigated. In 1911, Kelling described the use of colon for esophageal replacement (7). The use of stomach, based on the right gastroepiploic artery and the right gastric artery, was first demonstrated in the laboratory by Kirschner in 1920 (8). In 1933, Ohsava of Japan performed the first successful esophagectomy with an intrathoracic esophagogastric anastomosis through the left chest (9). This pioneering work was followed by similar reports from Marshall, Adams, Phemister, Churchill, and Sweet in the United States who advocated a left transthoracic approach (10–12). In 1946, Ivor Lewis reported esophageal resection through separate laparotomy and right chest incisions with an intrathoracic anastomosis at the apex of the right chest (5).
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