A multicenter randomized clinical trial compared robot-assisted oesophagectomy (RAO) with video-assisted thoracoscopic oesophagectomy (VAO) for oesophageal squamous cell carcinoma. The study involved 212 patients from three Asian centers, with 203 included in the analysis. The primary endpoint was the success rate of left recurrent laryngeal nerve (RLN) lymph node dissection, defined as the removal of at least one lymph node without causing nerve damage lasting more than 6 months. RAO achieved a higher success rate (88.3%) compared to VAO (69%) (P<0.001). The RAO group also had a lower incidence of RLN palsy at 1 week (20.4% vs 34%) and at 6 months (5.8% vs 20%) (P=0.029 and P=0.003, respectively). RAO also resulted in more mediastinal lymph nodes being dissected (median 16 vs 14). Postoperative complication rates were comparable between the two groups, with no in-hospital deaths. The study concluded that RAO leads to more successful RLN lymph node dissection and a lower rate of short- and long-term RLN injury compared to VAO. The trial was registered at ClinicalTrials.gov (NCT03713749). The study was well-designed, with randomization and blinding, and followed CONSORT guidelines. The results suggest that RAO may provide better lymph node removal and less nerve injury than VAO for oesophageal cancer surgery. However, the study has limitations, including the use of experienced surgeons in high-volume centers and the lack of cost-effectiveness analysis. The findings may not be generalizable to all patients or settings.A multicenter randomized clinical trial compared robot-assisted oesophagectomy (RAO) with video-assisted thoracoscopic oesophagectomy (VAO) for oesophageal squamous cell carcinoma. The study involved 212 patients from three Asian centers, with 203 included in the analysis. The primary endpoint was the success rate of left recurrent laryngeal nerve (RLN) lymph node dissection, defined as the removal of at least one lymph node without causing nerve damage lasting more than 6 months. RAO achieved a higher success rate (88.3%) compared to VAO (69%) (P<0.001). The RAO group also had a lower incidence of RLN palsy at 1 week (20.4% vs 34%) and at 6 months (5.8% vs 20%) (P=0.029 and P=0.003, respectively). RAO also resulted in more mediastinal lymph nodes being dissected (median 16 vs 14). Postoperative complication rates were comparable between the two groups, with no in-hospital deaths. The study concluded that RAO leads to more successful RLN lymph node dissection and a lower rate of short- and long-term RLN injury compared to VAO. The trial was registered at ClinicalTrials.gov (NCT03713749). The study was well-designed, with randomization and blinding, and followed CONSORT guidelines. The results suggest that RAO may provide better lymph node removal and less nerve injury than VAO for oesophageal cancer surgery. However, the study has limitations, including the use of experienced surgeons in high-volume centers and the lack of cost-effectiveness analysis. The findings may not be generalizable to all patients or settings.