Assessment of the educational approaches for robotic minimally invasive esophagectomy

Esophagectomy is a key element in the trimodal therapy for esophageal cancer. The advancement in minimally invasive and robotic technique have reduced the morbidity and mortality associated with open esophagectomy while improving the postoperative quality of life without affecting the oncological outcomes. This has reduced operative length of stay and increased the chance of patient receiving adjuvant systemic therapy. Recently, the number of esophagectomies performed minimally invasively have surpassed open esophagectomy. However, implementation of innovative surgical techniques always faces a learning curve that delays its adaptation. Anastomotic leaks can increase during the learning curve for both conventional minimally invasive and robotic assisted minimally invasive esophagectomy. Multiple authors have documented the number of esophagectomies needed to achieve proficiency or overcome the learning curve morbidity. This review focus on complete video assisted approaches (laparoscopic, thoracoscopic and robotic approaches). Utilizing a trans-hiatal or a hybrid approach can be considered minimally invasive by some but it's outside the scope of this review. Determining the ideal educational program is challenging due to the complexity and variety of required skills in both the abdomen and chest. The absence of a standardized and validated robotic esophagectomy curriculum demonstrates the need for a thoughtful approach to prepare trainee and surgeons to adapt these approaches. Establishing dedicated training centers supervised by surgical and academic societies may help surgeons from lower volume centers adapt these techniques.