SPECIALISED PROCEDURE

Robotic oesophagectomy

Q: "How long does the operation take?"

"Depending on the technique and individual situation, 4–7 hours. Anaesthetic preparation and recovery are added on top."

Q: "How long will I be in hospital?"

"Typically 7–14 days, depending on the postoperative course and anastomotic healing."

Q: "Will I have severe pain after the operation?"

"We follow a modern pain management concept with epidural anaesthesia and multimodal analgesia. Pain control is good for the majority of patients."

Q: "When can I eat again?"

"After anastomotic verification by EGD on day 5–7, oral intake begins gradually — first liquids, then puréed food, finally solid food. A dietitian accompanies this phase."

Q: "When can I return to work?"

"Depending on profession and individual recovery, 6–12 weeks. For physically demanding occupations, longer time off work is common."

Q: "What are the risks?"

"Significant risks include anastomotic leak, pulmonary complications, bleeding and, in rare cases, conversion to open surgery. These are discussed individually during the informed-consent consultation."

Q: "What is a prophylactic eVAC?"

"Endoluminal vacuum therapy — a small sponge catheter is placed intraoperatively to stabilise the anastomosis during the first days. Studies suggest this can reduce the complication rate in high-risk anastomoses."

Q: "What happens at 3, 6 and 12 months?"

"Structured follow-up along the tumour-board pathway with clinical examination, imaging (CT, PET-CT if indicated) and endoscopy on a fixed schedule. The general practitioner and oncology team are closely involved."

Surgical removal of the oesophagus — robot-assisted, minimally invasive and embedded in a structured care pathway. The following is a professional overview of indication, surgical technique, platform, pathway and frequently asked questions from a patient's perspective.

Robot-assisted procedure on the Da Vinci system

INDICATION AND PATIENT CRITERIA

Who benefits from a robotic oesophagectomy?

Main indication: operable adenocarcinoma or squamous cell carcinoma of the oesophagus.

Extended indication: high-grade dysplasia in long-segment Barrett's oesophagus with surveillance failure, selected achalasia cases.

Prerequisites:

Multidisciplinary tumour-board presentation
Complete preoperative staging (CT/PET-CT, EGD with biopsy, endosonography, pulmonary function testing)
Adequate general condition (ECOG ≤ 2, FEV1 ≥ 1.5 L)
Structured patient education and informed consent

SURGICAL TECHNIQUE

Three approaches — chosen by tumour and patient

The choice of technique depends on tumour location, lymphatic drainage and individual risk profile.

TRANSTHORACIC-TRANSABDOMINAL

Ivor Lewis oesophagectomy

Indication: distal and middle-third oesophageal carcinomas, adenocarcinomas of the gastro-oesophageal junction (Siewert I/II).

Anastomosis: thoracic (right-sided), gastric pull-up, stapled or hand-sewn.

Advantages: lower anastomotic leak rate than cervical anastomosis, good lymphadenectomy.

Disadvantages: thoracic procedure required, double-lumen endotracheal tube.

THREE-FIELD PROCEDURE

McKeown oesophagectomy

Indication: proximal and middle-third oesophageal carcinomas, extensive cervical-mediastinal-abdominal lymphadenectomy.

Anastomosis: left cervical, gastric pull-up to the neck.

Advantages: extensive lymphadenectomy, safe resection margin for high-lying tumours.

Disadvantages: higher cervical leak rate, longer gastric pull-up distance.

TRANSHIATAL · SP-RACE

Transhiatal oesophagectomy

Indication: distal tumours in patients with reduced pulmonary function or prior thoracic surgery.

Anastomosis: cervical, transhiatal access without thoracotomy.

Advantages: no thoracic procedure required, lower rate of pulmonary complications.

Robotic variant: SP-RACE (single-port robot-assisted cervical oesophagectomy) using Da Vinci SP — Mainz, Prof. Grimminger.

PLATFORM EXPERTISE

Da Vinci Xi and Da Vinci SP

Both platforms are used purposefully — Xi for transthoracic-transabdominal procedures, SP for the transcervical approach without thoracotomy.

Da Vinci Xi

Application: Standard platform for Ivor Lewis and McKeown — transthoracic-transabdominal.

Features: Four-arm system, 3D HD optics, wide range of instrument motion, integrated stapler.

Experience: Console surgeon certification 2024 (RAIN Robotic Academy, Naples).

Da Vinci SP (single-port)

Application: SP-RACE — transcervical oesophagectomy via single-port access.

Specifics: No entry into the thorax — single-lung ventilation is not required. Also suitable for patients with reduced pulmonary function.

Mainz experience: ESDE fellowship 2024/2025 with Prof. Grimminger, parallel two-team operations to shorten anaesthesia time.

PERIOPERATIVE PATHWAY

ERAS, prophylactic eVAC, tumour board, follow-up

Preoperative: Tumour board presentation, staging conference, nutritional optimisation, respiratory therapy, neoadjuvant chemotherapy or chemoradiotherapy where indicated.
Intraoperative: ERAS-compliant anaesthesia, intraoperative endoscopy for anastomotic check, prophylactic endoluminal vacuum therapy (eVAC) for high-risk anastomoses.
Postoperative: ERAS pathway, early mobilisation, gradual oral diet, anastomotic check by upper GI endoscopy at 5–7 days.
Follow-up: Follow-up at six weeks, tumour board follow-up, regular imaging according to tumour stage, close cooperation with the general practitioner and oncology.

eVAC methodology published in Adamenko et al., Langenbeck's Archives of Surgery 2024;409:220.

FREQUENTLY ASKED QUESTIONS

From a patient's perspective — frequently asked questions

The following answers provide guidance. Individual values may vary — happy to discuss in detail at consultation.

How long does the operation take?

Depending on the technique and individual situation, 4–7 hours. Anaesthetic preparation and recovery are added on top.

How long will I be in hospital?

Typically 7–14 days, depending on the postoperative course and anastomotic healing.

Will I have severe pain after the operation?

We follow a modern pain management concept with epidural anaesthesia and multimodal analgesia. Pain control is good for the majority of patients.

When can I eat again?

After anastomotic verification by EGD on day 5–7, oral intake begins gradually — first liquids, then puréed food, finally solid food. A dietitian accompanies this phase.

When can I return to work?

Depending on profession and individual recovery, 6–12 weeks. For physically demanding occupations, longer time off work is common.

What are the risks?

Significant risks include anastomotic leak, pulmonary complications, bleeding and, in rare cases, conversion to open surgery. These are discussed individually during the informed-consent consultation.

What is a prophylactic eVAC?

Endoluminal vacuum therapy — a small sponge catheter is placed intraoperatively to stabilise the anastomosis during the first days. Studies suggest this can reduce the complication rate in high-risk anastomoses.

What happens at 3, 6 and 12 months?

Structured follow-up along the tumour-board pathway with clinical examination, imaging (CT, PET-CT if indicated) and endoscopy on a fixed schedule. The general practitioner and oncology team are closely involved.

TUMOUR BOARD AND NETWORK

Embedded in an interdisciplinary network

Every indication for an oesophagectomy is discussed in the interdisciplinary tumour board. The practice is closely networked with GITZ, Klinik Hirslanden, Klinik im Park, Swiss Surgery and internationally with the University Medical Centre Mainz and the ESDE.

→ View network and partners

QUICK REFERRAL

Direct accessibility for referring doctors

OFFICE HOURS

Mon–Fri 8:00 AM – 5:00 PM

Outside office hours: Klinik Hirslanden emergency +41 44 387 21 11

DIRECT CONTACT

CONTACT PERSON

MPA-Team

MPA team — answers referrer inquiries within 24 hours on working days.

DOCUMENTS FOR REFERRAL

Reports from previous treating physicians
Imaging (CD or PACS token)
Insurance card number (20 digits)

Last clinical review: 3. Januar 2026