{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T15:07:41Z","timestamp":1784041661995,"version":"3.55.0"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100014584","name":"Universit\u00e4tsmedizin der Johannes Gutenberg-Universit\u00e4t Mainz","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100014584","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Left transcervical extrapleural esophageal mobilization can avoid pleural entry and one-lung ventilation but is limited by challenging exposure of the right paratracheal compartment and a relevant risk of left recurrent laryngeal nerve (RLN) injury. Prior bilateral transcervical approaches have been constrained by instrument collisions and limited caudal reach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a fresh-frozen cadaver, a right-first, bilateral transcervical single-port (SP) robotic strategy was performed with sequential right-then-left cervical docking under low-pressure pneumomediastinum. Feasibility endpoints were predefined: (i) reproducible access to the paratracheal and subcarinal planes, (ii) identification and preservation of the RLNs, (iii) maintenance of an extrapleural corridor to the diaphragmatic hiatus, and (iv) collision-free workflow.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Right-sided transcervical docking enabled near-circumferential thoracic esophageal mobilization with early identification of the right RLN and systematic mediastinal lymphadenectomy, including reliable exposure of the subcarinal station. The SP configuration allowed stable traction with two working instruments, facilitating controlled dissection without relevant internal or external collisions. The subsequent left-sided phase focused on completion of residual mobilization and targeted lymphadenectomy along the left RLN with minimal traction and limited energy application. All predefined feasibility criteria were met.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A threshold-guided (~\u200985%) right-first bilateral transcervical SP robotic approach is feasible in a cadaveric model. This strategy improves access to the right paratracheal nodal stations and may reduce traction on the left RLN by shifting traction-intensive steps to the right. Prospective clinical translation is warranted to benchmark RLN outcomes, nodal yield, pleural integrity, and recovery against current transcervical and transthoracic techniques.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00464-026-12792-8","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T17:46:09Z","timestamp":1776707169000},"page":"5769-5779","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Right-first bilateral transcervical single-port robotic esophagectomy: a cadaveric feasibility study toward a safer extrapleural strategy"],"prefix":"10.1007","volume":"40","author":[{"given":"Olga","family":"Meier","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Greenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Kemper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yulia","family":"Brecht","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franziska","family":"Renger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Daiko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1859-9213","authenticated-orcid":false,"given":"Peter P.","family":"Grimminger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"12792_CR1","doi-asserted-by":"publisher","first-page":"1617","DOI":"10.1007\/s00464-024-10692-3","volume":"38","author":"T Fujita","year":"2024","unstructured":"Fujita T, Sato K, Fujiwara N, Kajiyama D, Shigeno T, Otomo M et al (2024) Robot-assisted transcervical esophagectomy with a bilateral cervical approach for thoracic esophagectomy. Surg Endosc 38:1617\u20131625","journal-title":"Surg Endosc"},{"key":"12792_CR2","doi-asserted-by":"publisher","first-page":"6413","DOI":"10.1007\/s00464-024-11214-x","volume":"38","author":"T Fujita","year":"2024","unstructured":"Fujita T, Sato K, Fujiwara N, Kajiyama D, Kubo Y, Daiko H (2024) Robot-assisted cervical esophagectomy with simultaneous transhiatal abdominal procedure for thoracic esophageal carcinoma. Surg Endosc 38:6413\u20136422","journal-title":"Surg Endosc"},{"key":"12792_CR3","doi-asserted-by":"publisher","first-page":"5186","DOI":"10.1007\/s00464-020-08012-6","volume":"35","author":"H Daiko","year":"2021","unstructured":"Daiko H, Oguma J, Fujiwara H, Ishiyama K, Kurita D, Sato T et al (2021) Novel universally applicable technique for performing bilateral transcervical mediastinoscopic-assisted transhiatal laparoscopic esophagectomy: a truly minimally invasive procedure. Surg Endosc 35:5186\u20135192","journal-title":"Surg Endosc"},{"issue":"5","key":"12792_CR4","doi-asserted-by":"publisher","first-page":"209","DOI":"10.5090\/jcs.25.031","volume":"58","author":"T Fujita","year":"2025","unstructured":"Fujita T (2025) Robot-assisted transcervical esophagectomy for thoracic esophageal carcinoma. J Chest Surg 58(5):209\u2013213","journal-title":"J Chest Surg"},{"key":"12792_CR5","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1055\/a-2405-2708","volume":"72","author":"E Hadzijusufovic","year":"2024","unstructured":"Hadzijusufovic E, Lozanovski VJ, Griemert E-V, Bellaio L, Lang H, Grimminger PP (2024) Single-port da Vinci robot\u2013assisted cervical esophagectomy: how to do it. Thorac Cardiovasc Surg 72:654\u2013658","journal-title":"Thorac Cardiovasc Surg"},{"key":"12792_CR6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/dote\/doac072","volume":"36","author":"ICLJ Filz von Reiterdank","year":"2023","unstructured":"Filz von Reiterdank ICLJ, Defize IL, de Groot EM, Wedel T, Grimminger PP, Egberts JH et al (2023) The surgical anatomy of a (robot-assisted) minimally invasive transcervical esophagectomy. Dis Esophagus 36:1\u201311","journal-title":"Dis Esophagus"},{"key":"12792_CR7","doi-asserted-by":"publisher","DOI":"10.3390\/app9173572","volume":"9","author":"PP Grimminger","year":"2019","unstructured":"Grimminger PP, van der Sluis PC, Stein H, Lang H, van Hillegersberg R, Egberts JH (2019) Feasibility of transcervical robotic-assisted esophagectomy (TC-RAMIE) in a cadaver study\u2014a future outlook for an extrapleural approach. 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Dis Esophagus 34:1\u20139","journal-title":"Dis Esophagus"},{"key":"12792_CR10","doi-asserted-by":"publisher","first-page":"1105","DOI":"10.1016\/S0140-6736(09)61116-8","volume":"374","author":"P McCulloch","year":"2009","unstructured":"McCulloch P, Altman DG, Campbell WB, Flum DR, Glasziou P, Marshall JC, Nicholl J, Balliol Collaboration (2009) No surgical innovation without evaluation: the IDEAL recommendations. Lancet 374:1105\u20131112","journal-title":"Lancet"},{"issue":"2","key":"12792_CR11","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1097\/SLA.0000000000002794","volume":"269","author":"A Hirst","year":"2019","unstructured":"Hirst A, Philippou Y, Blazeby J, Campbell B, Campbell M, Feinberg J et al (2019) No surgical innovation without evaluation: evolution and further development of the IDEAL framework and recommendations. 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Olga Meier (Adamenko), Yulia Brecht, Franziska Renger, Hiroyuki Daiko, and Peter P. Grimminger have no conflicts of interest or financial ties to disclose. Drs. Olga Greenberg and Justin Kemper are employees of Intuitive Surgical Inc.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosure"}},{"value":"This study was performed in a fresh-frozen cadaver model at a certified surgical research and training facility. No living human participants were involved; institutional review board approval and informed consent were not applicable for this cadaveric feasibility study according to local regulations.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}