Laparoscopic–Robotic-Assisted Ivor–Lewis Oesophagectomy Using CMR Versius System: A Single-Centre Early Implementation Case Series

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Abstract
Background: Evidence on Versius-assisted oesophagectomy remains limited. This retrospective single-centre case series describes the early implementation and outcomes of a fully minimally invasive Ivor–Lewis procedure comprising a laparoscopic abdominal phase and a Versius-assisted thoracic phase. Methods: A retrospective analysis was performed on prospectively collected data from 34 consecutive patients who underwent the RAMIE procedure using the Versius Surgical System at Klinikum Chemnitz between September 2024 and July 2025. The surgical technique consisted of a laparoscopic abdominal phase followed by a robotic thoracic phase with intrathoracic circular stapled anastomosis. The primary aim was to assess the safety and feasibility of using the Versius Surgical System in esophageal surgery. Results: The mean operative time was 329 min (range: 245–416), and the mean docking time was 11 min (range: 6–27). No conversions to laparoscopic or open procedures occurred (0%). R0 resection was achieved in 91.2% of patients. The median lymph node harvest was 28 (range: 15–44). The anastomotic leak rate was 8.8%, with no associated mortality. No deaths occurred within 90 days after surgery. Conclusions: In this initial single-centre series, the planned robotic Versius-assisted approach was completed in all patients. The observed perioperative and pathological outcomes provide preliminary descriptive evidence to support further prospective evaluation. They do not establish comparative safety, efficacy, or oncological equivalence.

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